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Posted
Posted

Dear Ruth

Absolutely. One small step for personkind, but a giant leap for the person.

I used to love my contact with health visitors..since I felt it was actually

about health

and the opportunity to work upstream with people. I think back to some great

people who not only helped

people to tear up a life-long script, but often one that had blighted their

family over generations.

Chris.

Re: RE: client perceptions of HV

Margaret/Chris/Ann/,

I am aware that I keep repeating myself, but I believe strongly that one of

the

main strengths of health visiting is the fact that we work at the

cross-roads of

the public health/medico/psycho/social services.We work in an independent

style

that enables us to acknowledge complexities in a client's life and wait

patiently for that individual to arrive at a point were they are ready for

action. We are then in a knowing position to signpost and support as they

make

what maybe a significant change for them but a microscopic change in a

public

health perspective. That is the strength and subtlety of family public

health as

delivered by health visitors. Oh, and yes, such patience, knowledge-base

and

skill requires a top-class employee who deserves a good wage and working

conditions in a capitalist society.

Ruth

Margaret Buttigieg wrote:

> Thanks you made me feel better.

>

> I have been feeling really old and tired the last few weeks but I feel

> better today and have had a good sorting day today so reading your

response

> now was an added tonic.

>

> I wanted to say to you Ann in response to your question to " by

> intuition and instinct " as I often feel I do my working with people by

feel

> and observation of their reactions but then I guess would probably

say

> that it is experience and development of understanding of people and all

> those things.

>

> I like your response to Ann in more depth and agree with it

entirely.

> I could apply it to many of the places I am working and find it incredible

> that those in the leading positions cannot see it what they need to do and

> the changes they need to make. But still if they did not have problems -

I

> would not get work so I suppose that is one consolilation.

>

> It seems to me that SENATE members could sort the world if they let us!!

>

> Margaret

>

> RE: client perceptions of HV

> > > > >

> > > > >

> > > > > > Margaret,

> > > > > > Jacky Moseley, from Norwich did a MSc on client views on HV.

She

> > >did

> > > > not

> > > > > > publish it but I think it highlighted things like the importance

> of

> > >the

> > > > > > personal relationship with clients which helped build their

> > >confidence

> > > > to

> > > > > > access/participate other services etc. Is this the stuff you

are

> > > > looking

> > > > > > at? I'm sure I haven't done it justice in the description but I

> can

> > >put

> > > > > you

> > > > > > in touch if you wish.

> > > > > > Charlene

> > > > > >

> > > > > >

> > > > > >

> > > > > >

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Posted
Posted

Dear Ruth,

You write 'We work in an independent style

that enables us to acknowledge complexities in a client's life and wait

patiently for that individual to arrive at a point were they are ready for

action'.

I only wish that this were true for all health visitors. The time allowed

to 'wait patiently' is sadly lacking in many places where there is

understaffing and an agenda that is driven by the needs of the service

rather that the needs of the client. In many places the one 'new birth

contact' is all that happens as far as a home visit is concerned and in that

visit the health visitor can feel constrained to give information about,

services, immunisation, development assessments, cot death, feeding, and

carry out a family health assessment sadly using a required questionnaire to

be completed. All this in itself can take at least an hour and then it is

time to move on to the next client. What chance is there for the client to

lead the agenda? Where is the time to wait patiently? Working in this way

would be ideal but I wonder how many health visitors in practice actually

have the time allowed and sufficient staffing levels to be able to do this?

Perhaps I'm being a bit pessimistic here. However, I cannot help

remembering a health visitor I was training in listening skills recently who

told me that if she really listened to clients then she might actually

discover something was wrong e.g. postnatal depression. Having discovered

this then she would be committed to more home visiting and she simply didn't

have the time. I was shocked that health visitors might not listen to

clients in order to avoid detecting health needs but as the same time more

than ever convinced that if one wants to discover health needs one only has

to listen to the client and be open to their agenda. This health visitor

obviously knew this and was actively avoiding doing it. Reform is obviously

needed in the way in which we work to allow us to spend time with people.

It is what clients want as I believe there is research that shows that

clients do value home visiting but consistently complain that there is not

enough of it.

RE: client perceptions of HV

> > > > > >

> > > > > >

> > > > > > > Margaret,

> > > > > > > Jacky Moseley, from Norwich did a MSc on client views on HV.

She

> > > >did

> > > > > not

> > > > > > > publish it but I think it highlighted things like the

importance

> > of

> > > >the

> > > > > > > personal relationship with clients which helped build their

> > > >confidence

> > > > > to

> > > > > > > access/participate other services etc. Is this the stuff you

are

> > > > > looking

> > > > > > > at? I'm sure I haven't done it justice in the description but

I

> > can

> > > >put

> > > > > > you

> > > > > > > in touch if you wish.

> > > > > > > Charlene

> > > > > > >

> > > > > > >

> > > > > > >

> > > > > > >

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Posted
Posted

Here Here and if people go to Elkan et al's review HTA you can

order it on line from

www.ncchta.org free to NHS employees £50 to others

they will clearly see that the evidence base exists that home visiting

works.

>From: " Bidmead " <christine@...>

>Reply-

>< >

>Subject: Re: RE: client perceptions of HV

>Date: Mon, 15 Apr 2002 09:07:05 +0100

>

>Dear Ruth,

>

>You write 'We work in an independent style

>that enables us to acknowledge complexities in a client's life and wait

>patiently for that individual to arrive at a point were they are ready for

>action'.

>

>I only wish that this were true for all health visitors. The time allowed

>to 'wait patiently' is sadly lacking in many places where there is

>understaffing and an agenda that is driven by the needs of the service

>rather that the needs of the client. In many places the one 'new birth

>contact' is all that happens as far as a home visit is concerned and in

>that

>visit the health visitor can feel constrained to give information about,

>services, immunisation, development assessments, cot death, feeding, and

>carry out a family health assessment sadly using a required questionnaire

>to

>be completed. All this in itself can take at least an hour and then it is

>time to move on to the next client. What chance is there for the client to

>lead the agenda? Where is the time to wait patiently? Working in this way

>would be ideal but I wonder how many health visitors in practice actually

>have the time allowed and sufficient staffing levels to be able to do this?

>

>Perhaps I'm being a bit pessimistic here. However, I cannot help

>remembering a health visitor I was training in listening skills recently

>who

>told me that if she really listened to clients then she might actually

>discover something was wrong e.g. postnatal depression. Having discovered

>this then she would be committed to more home visiting and she simply

>didn't

>have the time. I was shocked that health visitors might not listen to

>clients in order to avoid detecting health needs but as the same time more

>than ever convinced that if one wants to discover health needs one only has

>to listen to the client and be open to their agenda. This health visitor

>obviously knew this and was actively avoiding doing it. Reform is

>obviously

>needed in the way in which we work to allow us to spend time with people.

>It is what clients want as I believe there is research that shows that

>clients do value home visiting but consistently complain that there is not

>enough of it.

>

>

> RE: client perceptions of HV

> > > > > > >

> > > > > > >

> > > > > > > > Margaret,

> > > > > > > > Jacky Moseley, from Norwich did a MSc on client views on HV.

>She

> > > > >did

> > > > > > not

> > > > > > > > publish it but I think it highlighted things like the

>importance

> > > of

> > > > >the

> > > > > > > > personal relationship with clients which helped build their

> > > > >confidence

> > > > > > to

> > > > > > > > access/participate other services etc. Is this the stuff

>you

>are

> > > > > > looking

> > > > > > > > at? I'm sure I haven't done it justice in the description

>but

>I

> > > can

> > > > >put

> > > > > > > you

> > > > > > > > in touch if you wish.

> > > > > > > > Charlene

> > > > > > > >

> > > > > > > >

> > > > > > > >

> > > > > > > >

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Posted
Posted

I am talking about an inner London situation where the staffing levels are

down 30%-50% in the localities and staff are carrying caseloads of 400-500

families (not children) with high child protection and not enough social

workers to cover children on the CP register. This was a year ago and I am

aware that things are changing with the advent of the PCT. They certainly

needed to.

RE: client perceptions of HV

> > > > > > > >

> > > > > > > >

> > > > > > > > > Margaret,

> > > > > > > > > Jacky Moseley, from Norwich did a MSc on client views on

HV.

> > She

> > > > > >did

> > > > > > > not

> > > > > > > > > publish it but I think it highlighted things like the

> > importance

> > > > of

> > > > > >the

> > > > > > > > > personal relationship with clients which helped build

their

> > > > > >confidence

> > > > > > > to

> > > > > > > > > access/participate other services etc. Is this the stuff

you

> > are

> > > > > > > looking

> > > > > > > > > at? I'm sure I haven't done it justice in the description

but

> > I

> > > > can

> > > > > >put

> > > > > > > > you

> > > > > > > > > in touch if you wish.

> > > > > > > > > Charlene

> > > > > > > > >

> > > > > > > > >

> > > > > > > > >

> > > > > > > > >

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Posted
Posted

Sorry, I buried my response to Ruth's question at the end of a long message

(called opening the debate: because I think 'universal vs. selective' is such

an important issue), to which Woody has just responded. The points I was

making about the arithmetic of the spread of services applies here: numbers of

children/population do not equate to numbers of needs.

best wishes

Bidmead wrote:

> I am talking about an inner London situation where the staffing levels are

> down 30%-50% in the localities and staff are carrying caseloads of 400-500

> families (not children) with high child protection and not enough social

> workers to cover children on the CP register. This was a year ago and I am

> aware that things are changing with the advent of the PCT. They certainly

> needed to.

>

>

>

> RE: client perceptions of HV

> > > > > > > > >

> > > > > > > > >

> > > > > > > > > > Margaret,

> > > > > > > > > > Jacky Moseley, from Norwich did a MSc on client views on

> HV.

> > > She

> > > > > > >did

> > > > > > > > not

> > > > > > > > > > publish it but I think it highlighted things like the

> > > importance

> > > > > of

> > > > > > >the

> > > > > > > > > > personal relationship with clients which helped build

> their

> > > > > > >confidence

> > > > > > > > to

> > > > > > > > > > access/participate other services etc. Is this the stuff

> you

> > > are

> > > > > > > > looking

> > > > > > > > > > at? I'm sure I haven't done it justice in the description

> but

> > > I

> > > > > can

> > > > > > >put

> > > > > > > > > you

> > > > > > > > > > in touch if you wish.

> > > > > > > > > > Charlene

> > > > > > > > > >

> > > > > > > > > >

> > > > > > > > > >

> > > > > > > > > >

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Posted
Posted

I have been away working for a couple of days so am just catching up on the

debate.

How I agree with you - in places where I am working in inner and

outer London the health visitors seem to have little time to do anything

other than new birth visits, vulnerable families, child protection and

clinics. Staff shortages mean they are covering all over and GP attachments

often means they are travelling all over a PCT area from one end to the

other to visit families. and often the caseloads are not enormous - but all

the families will have complex needs and take time. Again to the actual

support like social services, voluntary organisations etc is poor so in many

ways when they make the statement below they are right. Mind set change

required!

One of the things I think is probably different for you Ruth - I am half way

through you dissertaion - is good or reasonable General Practice - that is

not always the case in inner London.

I have also had it said to me like , I do not want to seach for

need as I will not have time nor are there any resources to do anything

about it.

It seems to me that for some HVs because of the circumstances, the lack of

the support, low morale and so on doing anything more than the above is

impossible. What I work on is changing the mind set and the culture and

then looking at different ways of working and at the same time not accepting

the killer phrases like there is no recourses, we have tried that before, it

won't work etc. It is a slow job but change is possible and we will get

there.

The other point I pick up on is June's about nursery nurses - they are a

very valuable resource HVs need to learn ot use then effectively. Again a

problem is how senior managers see it and how they are introduced - poor

introduction can take over a year to resolve and then what do you do with

the staff nurse who has been doing the job the nursery nurse has been doing

for over 10 years apart from the immunisations. Change one area requires

change and thought elsewhere and how often does that happen.

I could go on but won't - I never thought asking about client perceptions

would spark such a debate!!

Margaret

RE: client perceptions of HV

> > > > > > > > >

> > > > > > > > >

> > > > > > > > > > Margaret,

> > > > > > > > > > Jacky Moseley, from Norwich did a MSc on client views on

> HV.

> > > She

> > > > > > >did

> > > > > > > > not

> > > > > > > > > > publish it but I think it highlighted things like the

> > > importance

> > > > > of

> > > > > > >the

> > > > > > > > > > personal relationship with clients which helped build

> their

> > > > > > >confidence

> > > > > > > > to

> > > > > > > > > > access/participate other services etc. Is this the

stuff

> you

> > > are

> > > > > > > > looking

> > > > > > > > > > at? I'm sure I haven't done it justice in the

description

> but

> > > I

> > > > > can

> > > > > > >put

> > > > > > > > > you

> > > > > > > > > > in touch if you wish.

> > > > > > > > > > Charlene

> > > > > > > > > >

> > > > > > > > > >

> > > > > > > > > >

> > > > > > > > > >

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Posted
Posted

can you explain how you would profile a caseload Ruth?Also Please try and

send your dissertation again.Thanks, Ann.

>From: ruthngrant <ruthngrant@...>

>Reply-

>

>Subject: Re: RE: client perceptions of HV

>Date: Mon, 08 Apr 2002 22:31:50 +0100

>

>I agree entirely , but I am sure that there are upper limits to the

>numbers of

>individuals (regardless of level of need) that one HV can relate to.

>Perhaps the

>poor staff in those areas lists have reached that limit. Would

>there be

>any value in profiling those individuals case loads - at least then service

>providers would know the upper limits/situations that should trigger

>emergency

>situations?

>

>Ruth

>

> Cowley wrote:

>

> > Sorry, I buried my response to Ruth's question at the end of a long

>message

> > (called opening the debate: because I think 'universal vs. selective'

>is such

> > an important issue), to which Woody has just responded. The points I

>was

> > making about the arithmetic of the spread of services applies here:

>numbers of

> > children/population do not equate to numbers of needs.

> >

> > best wishes

> >

> > Bidmead wrote:

> >

> > > I am talking about an inner London situation where the staffing levels

>are

> > > down 30%-50% in the localities and staff are carrying caseloads of

>400-500

> > > families (not children) with high child protection and not enough

>social

> > > workers to cover children on the CP register. This was a year ago and

>I am

> > > aware that things are changing with the advent of the PCT. They

>certainly

> > > needed to.

> > >

> > >

> > >

> > > RE: client perceptions of HV

> > > > > > > > > > >

> > > > > > > > > > >

> > > > > > > > > > > > Margaret,

> > > > > > > > > > > > Jacky Moseley, from Norwich did a MSc on client

>views on

> > > HV.

> > > > > She

> > > > > > > > >did

> > > > > > > > > > not

> > > > > > > > > > > > publish it but I think it highlighted things like

>the

> > > > > importance

> > > > > > > of

> > > > > > > > >the

> > > > > > > > > > > > personal relationship with clients which helped

>build

> > > their

> > > > > > > > >confidence

> > > > > > > > > > to

> > > > > > > > > > > > access/participate other services etc. Is this the

>stuff

> > > you

> > > > > are

> > > > > > > > > > looking

> > > > > > > > > > > > at? I'm sure I haven't done it justice in the

>description

> > > but

> > > > > I

> > > > > > > can

> > > > > > > > >put

> > > > > > > > > > > you

> > > > > > > > > > > > in touch if you wish.

> > > > > > > > > > > > Charlene

> > > > > > > > > > > >

> > > > > > > > > > > >

> > > > > > > > > > > >

> > > > > > > > > > > >

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Posted
Posted

That is a good point Ruth and clients persistently tell us (even though our

paymasters

do not always want to believe them) that personal relationships matter

enormously. I

am not sure that health visiting is only about relating to individuals though.

Even

though that is surely an absolutely fundamental requirement, there is the wider

public

health issue of an overview of the health needs in an area, which may not appear

in a

traditional form of caseload. I think it is where that has gone awry, that the

numbers of HVs have been allowed to drift downwards so badly.

There has always been a debate, too, about the meaning of the term 'caseload'.

Is it

measured in terms of indexed children aged under five? Or does it include their

families? (if so, who counts as 'family'?) Or files in the filing cabinet? Or

active

cases? Or is it closer to the idea of the GP caselist, with HVs having a

responsibility for people that they rarely see, but who know they can turn to

the HV

if they need her? (GPs usually, I think, have 2,000 or even 3,000 individuals

on

their list). Is it about individuals, or something else? What about a

geographic

area or a school or, bearing in mind Jan's fascinating description of her work,

a

prison?

I wonder if others, like me, worry about the often-expressed view that we should

be

swapping 'caseloads' for 'public health' work? I do not want to suggest that we

should

be ignoring that wider public health/community view, because I believe it is the

combination of individual plus community-wide work that is distinctive to

health

visiting. It also happens to be what the evidence shows works best in terms of

health

improvement. best wishes

ruthngrant wrote:

> I agree entirely , but I am sure that there are upper limits to the

numbers of

> individuals (regardless of level of need) that one HV can relate to. Perhaps

the

> poor staff in those areas lists have reached that limit. Would

there be

> any value in profiling those individuals case loads - at least then service

> providers would know the upper limits/situations that should trigger emergency

> situations?

>

> Ruth

>

> Cowley wrote:

>

> > Sorry, I buried my response to Ruth's question at the end of a long message

> > (called opening the debate: because I think 'universal vs. selective' is

such

> > an important issue), to which Woody has just responded. The points I was

> > making about the arithmetic of the spread of services applies here: numbers

of

> > children/population do not equate to numbers of needs.

> >

> > best wishes

> >

> > Bidmead wrote:

> >

> > > I am talking about an inner London situation where the staffing levels are

> > > down 30%-50% in the localities and staff are carrying caseloads of 400-500

> > > families (not children) with high child protection and not enough social

> > > workers to cover children on the CP register. This was a year ago and I

am

> > > aware that things are changing with the advent of the PCT. They certainly

> > > needed to.

> > >

> > >

> > >

> > > Re: RE: client perceptions of HV

> > > > >

> > > > > > Margaret/Chris/Ann/,

> > > > > > I am aware that I keep repeating myself, but I believe strongly that

> > > one

> > > > > of the

> > > > > > main strengths of health visiting is the fact that we work at the

> > > > > cross-roads of

> > > > > > the public health/medico/psycho/social services.We work in an

> > > independent

> > > > > style

> > > > > > that enables us to acknowledge complexities in a client's life and

> > > wait

> > > > > > patiently for that individual to arrive at a point were they are

ready

> > > for

> > > > > > action. We are then in a knowing position to signpost and support

as

> > > they

> > > > > make

> > > > > > what maybe a significant change for them but a microscopic change in

a

> > > > > public

> > > > > > health perspective. That is the strength and subtlety of family

public

> > > > > health as

> > > > > > delivered by health visitors. Oh, and yes, such patience,

> > > knowledge-base

> > > > > and

> > > > > > skill requires a top-class employee who deserves a good wage and

> > > working

> > > > > > conditions in a capitalist society.

> > > > > >

> > > > > > Ruth

> > > > > >

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Posted
Posted

Dear Margaret

Could you go into some more detail here about the mind sets of HVs, so that

I can understand this with

my educators hat on..so that those healthcare professionals I work with are

moved towards your sphere

of activity in an aligned manner. This would also be very helpful to me with

my taskforce hat on.

Some handy tips as to how YOU change mind sets would also be

helpful..without asking you to give away your business..but there is so much

to be done here, as you say, that the more of us are working in an aligned

way the better.

Best Wishes

Chris.

Re: RE: client perceptions of HV

I have been away working for a couple of days so am just catching up on the

debate.

How I agree with you - in places where I am working in inner and

outer London the health visitors seem to have little time to do anything

other than new birth visits, vulnerable families, child protection and

clinics. Staff shortages mean they are covering all over and GP attachments

often means they are travelling all over a PCT area from one end to the

other to visit families. and often the caseloads are not enormous - but all

the families will have complex needs and take time. Again to the actual

support like social services, voluntary organisations etc is poor so in many

ways when they make the statement below they are right. Mind set change

required!

One of the things I think is probably different for you Ruth - I am half way

through you dissertaion - is good or reasonable General Practice - that is

not always the case in inner London.

I have also had it said to me like , I do not want to seach for

need as I will not have time nor are there any resources to do anything

about it.

It seems to me that for some HVs because of the circumstances, the lack of

the support, low morale and so on doing anything more than the above is

impossible. What I work on is changing the mind set and the culture and

then looking at different ways of working and at the same time not accepting

the killer phrases like there is no recourses, we have tried that before, it

won't work etc. It is a slow job but change is possible and we will get

there.

The other point I pick up on is June's about nursery nurses - they are a

very valuable resource HVs need to learn ot use then effectively. Again a

problem is how senior managers see it and how they are introduced - poor

introduction can take over a year to resolve and then what do you do with

the staff nurse who has been doing the job the nursery nurse has been doing

for over 10 years apart from the immunisations. Change one area requires

change and thought elsewhere and how often does that happen.

I could go on but won't - I never thought asking about client perceptions

would spark such a debate!!

Margaret

RE: client perceptions of HV

> > > > > > > > >

> > > > > > > > >

> > > > > > > > > > Margaret,

> > > > > > > > > > Jacky Moseley, from Norwich did a MSc on client views on

> HV.

> > > She

> > > > > > >did

> > > > > > > > not

> > > > > > > > > > publish it but I think it highlighted things like the

> > > importance

> > > > > of

> > > > > > >the

> > > > > > > > > > personal relationship with clients which helped build

> their

> > > > > > >confidence

> > > > > > > > to

> > > > > > > > > > access/participate other services etc. Is this the

stuff

> you

> > > are

> > > > > > > > looking

> > > > > > > > > > at? I'm sure I haven't done it justice in the

description

> but

> > > I

> > > > > can

> > > > > > >put

> > > > > > > > > you

> > > > > > > > > > in touch if you wish.

> > > > > > > > > > Charlene

> > > > > > > > > >

> > > > > > > > > >

> > > > > > > > > >

> > > > > > > > > >

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Posted
Posted

Surely

If users perceptions and individual caseloads were being included in the

overall strategy for a PCTs approach to its community, then they would come

together within that and inform the strategy and the PH issues..in effect

they map and gap the PH needs for the PCT..this should be applying to all

health and social care professionals and is one of the reasons why we MUST

have integrated means of cross-commincation and information sharing and

joined up IT. Smart decision-making software and case notes centred on the

user (in a way that can be delivered electronically through central storage,

so that everyone involved in care, including the user and carer, has access

to those notes), instead of being stored in separate silos would enable this

process considerably...since the file would be accessible 24 x 7 and

relating through the user would bring us all closer together..because that

is why we are there in the first place?

The problem as I see it is that we are becoming hopelessly task orientated

with measurement and assessment ++ to satisfy the bean-counters, but not

enough people to meet the needs. I think this is a case for volunteers who

do all the records..why not HVs and vols from the community on some work?

Quite good to have companions too and what about vols doing some visiting.

The system is paying for the collapse of community and PCTs should be making

that their number one priority..building that capacity up and sharing the

workload.. not everyone being funneled through the medical model..this would

also free up health and social care resources to focus on the top line

issues

Chris.

Re: RE: client perceptions of HV

That is a good point Ruth and clients persistently tell us (even though our

paymasters

do not always want to believe them) that personal relationships matter

enormously. I

am not sure that health visiting is only about relating to individuals

though. Even

though that is surely an absolutely fundamental requirement, there is the

wider public

health issue of an overview of the health needs in an area, which may not

appear in a

traditional form of caseload. I think it is where that has gone awry, that

the

numbers of HVs have been allowed to drift downwards so badly.

There has always been a debate, too, about the meaning of the term

'caseload'. Is it

measured in terms of indexed children aged under five? Or does it include

their

families? (if so, who counts as 'family'?) Or files in the filing cabinet?

Or active

cases? Or is it closer to the idea of the GP caselist, with HVs having a

responsibility for people that they rarely see, but who know they can turn

to the HV

if they need her? (GPs usually, I think, have 2,000 or even 3,000

individuals on

their list). Is it about individuals, or something else? What about a

geographic

area or a school or, bearing in mind Jan's fascinating description of her

work, a

prison?

I wonder if others, like me, worry about the often-expressed view that we

should be

swapping 'caseloads' for 'public health' work? I do not want to suggest that

we should

be ignoring that wider public health/community view, because I believe it is

the

combination of individual plus community-wide work that is distinctive to

health

visiting. It also happens to be what the evidence shows works best in terms

of health

improvement. best wishes

ruthngrant wrote:

> I agree entirely , but I am sure that there are upper limits to the

numbers of

> individuals (regardless of level of need) that one HV can relate to.

Perhaps the

> poor staff in those areas lists have reached that limit. Would

there be

> any value in profiling those individuals case loads - at least then

service

> providers would know the upper limits/situations that should trigger

emergency

> situations?

>

> Ruth

>

> Cowley wrote:

>

> > Sorry, I buried my response to Ruth's question at the end of a long

message

> > (called opening the debate: because I think 'universal vs. selective'

is such

> > an important issue), to which Woody has just responded. The points I

was

> > making about the arithmetic of the spread of services applies here:

numbers of

> > children/population do not equate to numbers of needs.

> >

> > best wishes

> >

> > Bidmead wrote:

> >

> > > I am talking about an inner London situation where the staffing levels

are

> > > down 30%-50% in the localities and staff are carrying caseloads of

400-500

> > > families (not children) with high child protection and not enough

social

> > > workers to cover children on the CP register. This was a year ago and

I am

> > > aware that things are changing with the advent of the PCT. They

certainly

> > > needed to.

> > >

> > >

> > >

> > > Re: RE: client perceptions of HV

> > > > >

> > > > > > Margaret/Chris/Ann/,

> > > > > > I am aware that I keep repeating myself, but I believe strongly

that

> > > one

> > > > > of the

> > > > > > main strengths of health visiting is the fact that we work at

the

> > > > > cross-roads of

> > > > > > the public health/medico/psycho/social services.We work in an

> > > independent

> > > > > style

> > > > > > that enables us to acknowledge complexities in a client's life

and

> > > wait

> > > > > > patiently for that individual to arrive at a point were they are

ready

> > > for

> > > > > > action. We are then in a knowing position to signpost and

support as

> > > they

> > > > > make

> > > > > > what maybe a significant change for them but a microscopic

change in a

> > > > > public

> > > > > > health perspective. That is the strength and subtlety of family

public

> > > > > health as

> > > > > > delivered by health visitors. Oh, and yes, such patience,

> > > knowledge-base

> > > > > and

> > > > > > skill requires a top-class employee who deserves a good wage and

> > > working

> > > > > > conditions in a capitalist society.

> > > > > >

> > > > > > Ruth

> > > > > >

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Dear Ruth

Whose evidence is it anyway? Why is it that just about every other business

places such high store and value on the user experience of the product. Is

there no evidence that communication and quality of continuity of care®

make little difference to outcomes? How are we bamboozled by seemingly

robust justifications that actually fall over when challenged...I think it

is very easy for people to sound so convincing..but I think we should all be

grouping together to give these folks who have so much certainty that they

are right, a bit more of a buffeting..how do we know what we know? how well

do we know it? I would argue that the loss of experience and narrative is

doing so much to destroy our connections with others. Look at what the

evidence has done in terms, over my lifetime alone, in terms of what we

shoul/should not be eating/drinking/doing and anyway..many of the

interventions that are going to count in people's lives are not going to

come from official systems or even from DH budgets.

Has anyone noticed how there is a remarkable co-terminosity between what

funders consider to be important areas of activity

and the evidence available..and how this still so often relates, in a

completely objective way, of course, to issues around

minimising the costs of service delivery.

We desperately need to start showing how process matters as much as

outcome..it is incredible how we particulate life and then forget to put it

back together. We need longitudinal qualitative research..a person's story

or narrative is not " just anecdotal " ..these are high order brains telling us

the measurements of how we are doing. In public health terms, if many

employees in a factory are sick with mental ill-health or stress-related

illness..they are telling us about the levels of psychotoxicity in their

working environments, in the same way

as canaries died when the coal gas levels went up..it IS evidence!! Whether

bean counting bureacrats place a value on it or not,, does not take the

intrinsic value away. Evidence based practice MUST include personal

experience and intelligence gathered from whatever source.

There is a game to play here, which is to gain the funding for overt work

aligned to the funder's agendas, whilst doing the work in such a way that we

generate the results that will justify the quality agenda that we feel is

lacking. The evidence that we are not getting it right is burn-out and

demoralisation. WE NEED those missing elements and the research drive must

be to do the research which justifies the preservation of core values of

care and communication. We also need to remember to put all the evidence

back together again and remember that, whatever the evidence, there will

always be bean counters interested in its suppression (witness the original

Black report and the last Govt). We also need to remember that most of our

daily lives are not based on evidence and many of our human and caring

practices are not based on evidence that stands up to penetrative analysis,

in terms of the relevance of the studies to the people we may be seeing. And

maybe, all those who tell us how important it is may one days themselves

practice some form of evidence-based decision-making..I am thinking here of

party political decisions mostly. Is the evidence of a four year combative

political system convincing in terms of the development and sustaianbility

of the country's infrastructure eg?

And is it not remarkable that so much of what is happening is uncoupled from

any overall strategy coupled to evidence and funding must be for innovative

projects that usually fold after two-three years..too many pilots and not

enough fuel? Where is evidence-based politics..we have to justify every

penny, but the deeper you go within the system, the harder it is to identify

the monies..this too must change. If people are to hold the line on issues,

we must know the quantities.

Chris

www.primhe.org

Re: RE: client perceptions of HV

,

I am in the delicious position where the boundaries you mention are

coterminous and in an

area where the group of health visitors are dynamic and have always

persisted(covertly for

some of the time!) in public health initiatives - particularly knowledge of

local

facilities and networking with other agencies. We are, therefore, well

placed now to move

ahead with most of the baseline work already undertaken.

However, as the funding is linked to evidence, and acceptable evidence in

public health

terms (RCTs) is not always available we are in a bit of a Catch 22 with our

community

initiatives.

Ruth

Cowley wrote:

> That is a good point Ruth and clients persistently tell us (even though

our paymasters

> do not always want to believe them) that personal relationships matter

enormously. I

> am not sure that health visiting is only about relating to individuals

though. Even

> though that is surely an absolutely fundamental requirement, there is the

wider public

> health issue of an overview of the health needs in an area, which may not

appear in a

> traditional form of caseload. I think it is where that has gone awry,

that the

> numbers of HVs have been allowed to drift downwards so badly.

>

> There has always been a debate, too, about the meaning of the term

'caseload'. Is it

> measured in terms of indexed children aged under five? Or does it include

their

> families? (if so, who counts as 'family'?) Or files in the filing

cabinet? Or active

> cases? Or is it closer to the idea of the GP caselist, with HVs having a

> responsibility for people that they rarely see, but who know they can

turn to the HV

> if they need her? (GPs usually, I think, have 2,000 or even 3,000

individuals on

> their list). Is it about individuals, or something else? What about a

geographic

> area or a school or, bearing in mind Jan's fascinating description of her

work, a

> prison?

>

> I wonder if others, like me, worry about the often-expressed view that we

should be

> swapping 'caseloads' for 'public health' work? I do not want to suggest

that we should

> be ignoring that wider public health/community view, because I believe it

is the

> combination of individual plus community-wide work that is distinctive to

health

> visiting. It also happens to be what the evidence shows works best in

terms of health

> improvement. best wishes

>

>

>

> ruthngrant wrote:

>

> > I agree entirely , but I am sure that there are upper limits to the

numbers of

> > individuals (regardless of level of need) that one HV can relate to.

Perhaps the

> > poor staff in those areas lists have reached that limit.

Would there be

> > any value in profiling those individuals case loads - at least then

service

> > providers would know the upper limits/situations that should trigger

emergency

> > situations?

> >

> > Ruth

> >

> > Cowley wrote:

> >

> > > Sorry, I buried my response to Ruth's question at the end of a long

message

> > > (called opening the debate: because I think 'universal vs. selective'

is such

> > > an important issue), to which Woody has just responded. The points I

was

> > > making about the arithmetic of the spread of services applies here:

numbers of

> > > children/population do not equate to numbers of needs.

> > >

> > > best wishes

> > >

> > > Bidmead wrote:

> > >

> > > > I am talking about an inner London situation where the staffing

levels are

> > > > down 30%-50% in the localities and staff are carrying caseloads of

400-500

> > > > families (not children) with high child protection and not enough

social

> > > > workers to cover children on the CP register. This was a year ago

and I am

> > > > aware that things are changing with the advent of the PCT. They

certainly

> > > > needed to.

> > > >

> > > >

> > > >

> > > > Re: RE: client perceptions of HV

> > > > > >

> > > > > > > Margaret/Chris/Ann/,

> > > > > > > I am aware that I keep repeating myself, but I believe

strongly that

> > > > one

> > > > > > of the

> > > > > > > main strengths of health visiting is the fact that we work at

the

> > > > > > cross-roads of

> > > > > > > the public health/medico/psycho/social services.We work in an

> > > > independent

> > > > > > style

> > > > > > > that enables us to acknowledge complexities in a client's life

and

> > > > wait

> > > > > > > patiently for that individual to arrive at a point were they

are ready

> > > > for

> > > > > > > action. We are then in a knowing position to signpost and

support as

> > > > they

> > > > > > make

> > > > > > > what maybe a significant change for them but a microscopic

change in a

> > > > > > public

> > > > > > > health perspective. That is the strength and subtlety of

family public

> > > > > > health as

> > > > > > > delivered by health visitors. Oh, and yes, such patience,

> > > > knowledge-base

> > > > > > and

> > > > > > > skill requires a top-class employee who deserves a good wage

and

> > > > working

> > > > > > > conditions in a capitalist society.

> > > > > > >

> > > > > > > Ruth

> > > > > > >

>

>

>

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Posted
Posted

Dear Ruth, Margaret and all list

have put below a summary from my thesis as it is relevant to your

discussion. I used the effectiveness of interpersonal skills as a

marker for process to outcome evaluation. Clients provided the causal

link to demonstrate the effectiveness of interventions. They provided

examples of learning to demonstrate this effectiveness. Hope its

useful

THE VALUE OF HEALTH VISITORS' INTERPERSONAL SKILLS IN PROMOTING

HEALTH: A SEARCH FOR EVIDENCE OF EFFECTIVENESS

UWCM, CARDIFF, PhD 2000

DR LISA COLES RGN RHV BA PHD

THESIS SUMMARY

Health visiting interventions and their effect on outcomes are

difficult to evaluate. The promotion of health is fundamental to

health visiting and interpersonal skills are crucial to its success.

Interpersonal skills are said to be goal directed and amenable to

differentiation. Measuring the outcomes of health care and evaluating

health promotion both require a precision of taxonomy of

interventions. But the reality of the lived situation when working

with families challenges these constructs.

The participants for this qualitative process-to-outcome study were

all the health visitors employed in a South Wales Valley community

health service unit and some of their clients. Health visitors'

interpersonal skills and health promoting objectives were identified

from the content analysis of narratives of critical events, using

Flanagan's critical incident technique. For the clients' perception

of these skills and associated health gain, the text of tape recorded

in-depth semistructured interviews was analysed with the aid of the

NUD.IST qualitative data analysis software.

A taxonomy of the health visitors' interpersonal skills was built and

confirmed from the clients' perception. Causal links between the use

of skills and the outcomes of health attitude, knowledge and

behaviour changes were identified by clients. The health promotion

was client centred and relevant to social and psychological need,

incorporating adult emotional and relationship needs as much as baby

and child nutrition, behaviour and illness needs. It was evaluated as

successful by clients not through overt goal orientation but through

an informal concept of purposive befriending.

The way to measure the effectiveness of health visitors'

interpersonally skilled interventions is to seek from clients

evidence of learning outcomes and of satisfaction with the service.

Visibility of this qualitative data for evaluation purposes can be

increased by incorporating a relevant classification into current

nursing language databases about diagnosis, interventions and

outcomes. In addition, formal assessment of outcomes would benefit

from a framework that acknowledges interventions as relevant to the

context of needs. This takes the measurement of outcome away from a

medical model and into a socially constructed model.

Contact e-mail ColesEW@...

Telephone Work 029 2071 5479/6933

To leave a message anytime: 01446 760776

On 20 Apr 2002 at 14:52, Manning wrote:

Dear Ruth

Whose evidence is it anyway? Why is it that just about every other business

places such high store and value on the user experience of the product. Is

there no evidence that communication and quality of continuity of care®

make little difference to outcomes? How are we bamboozled by seemingly

robust justifications that actually fall over when challenged...I think it

is very easy for people to sound so convincing..but I think we should all be

grouping together to give these folks who have so much certainty that they

are right, a bit more of a buffeting..how do we know what we know? how well

do we know it? I would argue that the loss of experience and narrative is

doing so much to destroy our connections with others. Look at what the

evidence has done in terms, over my lifetime alone, in terms of what we

shoul/should not be eating/drinking/doing and anyway..many of the

interventions that are going to count in people's lives are not going to

come from official systems or even from DH budgets.

Has anyone noticed how there is a remarkable co-terminosity between what

funders consider to be important areas of activity

and the evidence available..and how this still so often relates, in a

completely objective way, of course, to issues around

minimising the costs of service delivery.

We desperately need to start showing how process matters as much as

outcome..it is incredible how we particulate life and then forget to put it

back together. We need longitudinal qualitative research..a person's story

or narrative is not " just anecdotal " ..these are high order brains telling us

the measurements of how we are doing. In public health terms, if many

employees in a factory are sick with mental ill-health or stress-related

illness..they are telling us about the levels of psychotoxicity in their

working environments, in the same way

as canaries died when the coal gas levels went up..it IS evidence!! Whether

bean counting bureacrats place a value on it or not,, does not take the

intrinsic value away. Evidence based practice MUST include personal

experience and intelligence gathered from whatever source.

There is a game to play here, which is to gain the funding for overt work

aligned to the funder's agendas, whilst doing the work in such a way that we

generate the results that will justify the quality agenda that we feel is

lacking. The evidence that we are not getting it right is burn-out and

demoralisation. WE NEED those missing elements and the research drive must

be to do the research which justifies the preservation of core values of

care and communication. We also need to remember to put all the evidence

back together again and remember that, whatever the evidence, there will

always be bean counters interested in its suppression (witness the original

Black report and the last Govt). We also need to remember that most of our

daily lives are not based on evidence and many of our human and caring

practices are not based on evidence that stands up to penetrative analysis,

in terms of the relevance of the studies to the people we may be seeing. And

maybe, all those who tell us how important it is may one days themselves

practice some form of evidence-based decision-making..I am thinking here of

party political decisions mostly. Is the evidence of a four year combative

political system convincing in terms of the development and sustaianbility

of the country's infrastructure eg?

And is it not remarkable that so much of what is happening is uncoupled from

any overall strategy coupled to evidence and funding must be for innovative

projects that usually fold after two-three years..too many pilots and not

enough fuel? Where is evidence-based politics..we have to justify every

penny, but the deeper you go within the system, the harder it is to identify

the monies..this too must change. If people are to hold the line on issues,

we must know the quantities.

Chris

www.primhe.org

Re: RE: client perceptions of HV

,

I am in the delicious position where the boundaries you mention are

coterminous and in an

area where the group of health visitors are dynamic and have always

persisted(covertly for

some of the time!) in public health initiatives - particularly knowledge of

local

facilities and networking with other agencies. We are, therefore, well

placed now to move

ahead with most of the baseline work already undertaken.

However, as the funding is linked to evidence, and acceptable evidence in

public health

terms (RCTs) is not always available we are in a bit of a Catch 22 with our

community

initiatives.

Ruth

Cowley wrote:

> That is a good point Ruth and clients persistently tell us (even though

our paymasters

> do not always want to believe them) that personal relationships matter

enormously. I

> am not sure that health visiting is only about relating to individuals

though. Even

> though that is surely an absolutely fundamental requirement, there is the

wider public

> health issue of an overview of the health needs in an area, which may not

appear in a

> traditional form of caseload. I think it is where that has gone awry,

that the

> numbers of HVs have been allowed to drift downwards so badly.

>

> There has always been a debate, too, about the meaning of the term

'caseload'. Is it

> measured in terms of indexed children aged under five? Or does it include

their

> families? (if so, who counts as 'family'?) Or files in the filing

cabinet? Or active

> cases? Or is it closer to the idea of the GP caselist, with HVs having a

> responsibility for people that they rarely see, but who know they can

turn to the HV

> if they need her? (GPs usually, I think, have 2,000 or even 3,000

individuals on

> their list). Is it about individuals, or something else? What about a

geographic

> area or a school or, bearing in mind Jan's fascinating description of her

work, a

> prison?

>

> I wonder if others, like me, worry about the often-expressed view that we

should be

> swapping 'caseloads' for 'public health' work? I do not want to suggest

that we should

> be ignoring that wider public health/community view, because I believe it

is the

> combination of individual plus community-wide work that is distinctive to

health

> visiting. It also happens to be what the evidence shows works best in

terms of health

> improvement. best wishes

>

>

>

> ruthngrant wrote:

>

> > I agree entirely , but I am sure that there are upper limits to the

numbers of

> > individuals (regardless of level of need) that one HV can relate to.

Perhaps the

> > poor staff in those areas lists have reached that limit.

Would there be

> > any value in profiling those individuals case loads - at least then

service

> > providers would know the upper limits/situations that should trigger

emergency

> > situations?

> >

> > Ruth

> >

> > Cowley wrote:

> >

> > > Sorry, I buried my response to Ruth's question at the end of a long

message

> > > (called opening the debate: because I think 'universal vs. selective'

is such

> > > an important issue), to which Woody has just responded. The points I

was

> > > making about the arithmetic of the spread of services applies here:

numbers of

> > > children/population do not equate to numbers of needs.

> > >

> > > best wishes

> > >

> > > Bidmead wrote:

> > >

> > > > I am talking about an inner London situation where the staffing

levels are

> > > > down 30%-50% in the localities and staff are carrying caseloads of

400-500

> > > > families (not children) with high child protection and not enough

social

> > > > workers to cover children on the CP register. This was a year ago

and I am

> > > > aware that things are changing with the advent of the PCT. They

certainly

> > > > needed to.

> > > >

> > > >

> > > >

> > > > Re: RE: client perceptions of HV

> > > > > >

> > > > > > > Margaret/Chris/Ann/,

> > > > > > > I am aware that I keep repeating myself, but I believe

strongly that

> > > > one

> > > > > > of the

> > > > > > > main strengths of health visiting is the fact that we work at

the

> > > > > > cross-roads of

> > > > > > > the public health/medico/psycho/social services.We work in an

> > > > independent

> > > > > > style

> > > > > > > that enables us to acknowledge complexities in a client's life

and

> > > > wait

> > > > > > > patiently for that individual to arrive at a point were they

are ready

> > > > for

> > > > > > > action. We are then in a knowing position to signpost and

support as

> > > > they

> > > > > > make

> > > > > > > what maybe a significant change for them but a microscopic

change in a

> > > > > > public

> > > > > > > health perspective. That is the strength and subtlety of

family public

> > > > > > health as

> > > > > > > delivered by health visitors. Oh, and yes, such patience,

> > > > knowledge-base

> > > > > > and

> > > > > > > skill requires a top-class employee who deserves a good wage

and

> > > > working

> > > > > > > conditions in a capitalist society.

> > > > > > >

> > > > > > > Ruth

> > > > > > >

>

>

>

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Ruth

It is really good to hear that someone is workingin this way within health

visiting and has the time and space to do so.

In the inner cities the health visitors are saying they do not even have

time to follow up on EPNDS so anything more would be out of the question.

Also the resources are just not there to follow up the identified need if it

bcomes to much for them to cope with which providesd another reason not to

search.

I know it is part of the mind set which has come about for a variety of

reasons but without guidance and development and the support of the PCt it

is extremely difficult to make a change.

Is it any wander Sure Start suggests we are not delivering what clients

want.

Margaret

Margaret

Re: RE: client perceptions of HV

> > > > > > > >

> > > > > > > > > Margaret/Chris/Ann/,

> > > > > > > > > I am aware that I keep repeating myself, but I believe

> > strongly that

> > > > > > one

> > > > > > > > of the

> > > > > > > > > main strengths of health visiting is the fact that we work

at

> > the

> > > > > > > > cross-roads of

> > > > > > > > > the public health/medico/psycho/social services.We work in

an

> > > > > > independent

> > > > > > > > style

> > > > > > > > > that enables us to acknowledge complexities in a client's

life

> > and

> > > > > > wait

> > > > > > > > > patiently for that individual to arrive at a point were

they

> > are ready

> > > > > > for

> > > > > > > > > action. We are then in a knowing position to signpost and

> > support as

> > > > > > they

> > > > > > > > make

> > > > > > > > > what maybe a significant change for them but a microscopic

> > change in a

> > > > > > > > public

> > > > > > > > > health perspective. That is the strength and subtlety of

> > family public

> > > > > > > > health as

> > > > > > > > > delivered by health visitors. Oh, and yes, such patience,

> > > > > > knowledge-base

> > > > > > > > and

> > > > > > > > > skill requires a top-class employee who deserves a good

wage

> > and

> > > > > > working

> > > > > > > > > conditions in a capitalist society.

> > > > > > > > >

> > > > > > > > > Ruth

> > > > > > > > >

> > >

> > >

> > >

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Posted
Posted

Ruth, could you check your system? I think you may have a virus. I

had some Senate emails from you in December which although

deleted kept returning on my system and then replicated. Our help

desk eventually came and cleaned my machine although they

didn't mention finding a virus.Your 9 April emails are doing the

same thing.

Many thanks.

Organization: Netscape Online member

From: ruthngrant <ruthngrant@...>

Date sent: Tue, 09 Apr 2002 13:33:12 +0100

Subject: Re: RE: client perceptions of HV

Send reply to:

[ Double-click this line for list subscription options ]

Thanks - a colleague of mine is writing a module of her Masters in Public

Health on client perceptions of HV service and I will offer your abstract.

Ruth

W Coles wrote:

> Dear Ruth, Margaret and all list

> have put below a summary from my thesis as it is relevant to your

> discussion. I used the effectiveness of interpersonal skills as a

> marker for process to outcome evaluation. Clients provided the causal

> link to demonstrate the effectiveness of interventions. They provided

> examples of learning to demonstrate this effectiveness. Hope its

> useful

>

>

> THE VALUE OF HEALTH VISITORS' INTERPERSONAL SKILLS IN PROMOTING

> HEALTH: A SEARCH FOR EVIDENCE OF EFFECTIVENESS

> UWCM, CARDIFF, PhD 2000

>

> DR LISA COLES RGN RHV BA PHD

>

> THESIS SUMMARY

> Health visiting interventions and their effect on outcomes are

> difficult to evaluate. The promotion of health is fundamental to

> health visiting and interpersonal skills are crucial to its success.

>

> Interpersonal skills are said to be goal directed and amenable to

> differentiation. Measuring the outcomes of health care and evaluating

> health promotion both require a precision of taxonomy of

> interventions. But the reality of the lived situation when working

> with families challenges these constructs.

>

> The participants for this qualitative process-to-outcome study were

> all the health visitors employed in a South Wales Valley community

> health service unit and some of their clients. Health visitors'

> interpersonal skills and health promoting objectives were identified

> from the content analysis of narratives of critical events, using

> Flanagan's critical incident technique. For the clients' perception

> of these skills and associated health gain, the text of tape recorded

> in-depth semistructured interviews was analysed with the aid of the

> NUD.IST qualitative data analysis software.

>

> A taxonomy of the health visitors' interpersonal skills was built and

> confirmed from the clients' perception. Causal links between the use

> of skills and the outcomes of health attitude, knowledge and

> behaviour changes were identified by clients. The health promotion

> was client centred and relevant to social and psychological need,

> incorporating adult emotional and relationship needs as much as baby

> and child nutrition, behaviour and illness needs. It was evaluated as

> successful by clients not through overt goal orientation but through

> an informal concept of purposive befriending.

>

> The way to measure the effectiveness of health visitors'

> interpersonally skilled interventions is to seek from clients

> evidence of learning outcomes and of satisfaction with the service.

> Visibility of this qualitative data for evaluation purposes can be

> increased by incorporating a relevant classification into current

> nursing language databases about diagnosis, interventions and

> outcomes. In addition, formal assessment of outcomes would benefit

> from a framework that acknowledges interventions as relevant to the

> context of needs. This takes the measurement of outcome away from a

> medical model and into a socially constructed model.

>

> Contact e-mail ColesEW@...

> Telephone Work 029 2071 5479/6933

> To leave a message anytime: 01446 760776

>

> On 20 Apr 2002 at 14:52, Manning wrote:

>

> Dear Ruth

>

> Whose evidence is it anyway? Why is it that just about every other business

> places such high store and value on the user experience of the product. Is

> there no evidence that communication and quality of continuity of care®

> make little difference to outcomes? How are we bamboozled by seemingly

> robust justifications that actually fall over when challenged...I think it

> is very easy for people to sound so convincing..but I think we should all be

> grouping together to give these folks who have so much certainty that they

> are right, a bit more of a buffeting..how do we know what we know? how well

> do we know it? I would argue that the loss of experience and narrative is

> doing so much to destroy our connections with others. Look at what the

> evidence has done in terms, over my lifetime alone, in terms of what we

> shoul/should not be eating/drinking/doing and anyway..many of the

> interventions that are going to count in people's lives are not going to

> come from official systems or even from DH budgets.

>

> Has anyone noticed how there is a remarkable co-terminosity between what

> funders consider to be important areas of activity

> and the evidence available..and how this still so often relates, in a

> completely objective way, of course, to issues around

> minimising the costs of service delivery.

>

> We desperately need to start showing how process matters as much as

> outcome..it is incredible how we particulate life and then forget to put it

> back together. We need longitudinal qualitative research..a person's story

> or narrative is not " just anecdotal " ..these are high order brains telling us

> the measurements of how we are doing. In public health terms, if many

> employees in a factory are sick with mental ill-health or stress-related

> illness..they are telling us about the levels of psychotoxicity in their

> working environments, in the same way

> as canaries died when the coal gas levels went up..it IS evidence!! Whether

> bean counting bureacrats place a value on it or not,, does not take the

> intrinsic value away. Evidence based practice MUST include personal

> experience and intelligence gathered from whatever source.

>

> There is a game to play here, which is to gain the funding for overt work

> aligned to the funder's agendas, whilst doing the work in such a way that we

> generate the results that will justify the quality agenda that we feel is

> lacking. The evidence that we are not getting it right is burn-out and

> demoralisation. WE NEED those missing elements and the research drive must

> be to do the research which justifies the preservation of core values of

> care and communication. We also need to remember to put all the evidence

> back together again and remember that, whatever the evidence, there will

> always be bean counters interested in its suppression (witness the original

> Black report and the last Govt). We also need to remember that most of our

> daily lives are not based on evidence and many of our human and caring

> practices are not based on evidence that stands up to penetrative analysis,

> in terms of the relevance of the studies to the people we may be seeing. And

> maybe, all those who tell us how important it is may one days themselves

> practice some form of evidence-based decision-making..I am thinking here of

> party political decisions mostly. Is the evidence of a four year combative

> political system convincing in terms of the development and sustaianbility

> of the country's infrastructure eg?

>

> And is it not remarkable that so much of what is happening is uncoupled from

> any overall strategy coupled to evidence and funding must be for innovative

> projects that usually fold after two-three years..too many pilots and not

> enough fuel? Where is evidence-based politics..we have to justify every

> penny, but the deeper you go within the system, the harder it is to identify

> the monies..this too must change. If people are to hold the line on issues,

> we must know the quantities.

>

> Chris

> www.primhe.org

>

> Re: RE: client perceptions of HV

>

> ,

>

> I am in the delicious position where the boundaries you mention are

> coterminous and in an

> area where the group of health visitors are dynamic and have always

> persisted(covertly for

> some of the time!) in public health initiatives - particularly knowledge of

> local

> facilities and networking with other agencies. We are, therefore, well

> placed now to move

> ahead with most of the baseline work already undertaken.

>

> However, as the funding is linked to evidence, and acceptable evidence in

> public health

> terms (RCTs) is not always available we are in a bit of a Catch 22 with our

> community

> initiatives.

>

> Ruth

> Cowley wrote:

>

> > That is a good point Ruth and clients persistently tell us (even though

> our paymasters

> > do not always want to believe them) that personal relationships matter

> enormously. I

> > am not sure that health visiting is only about relating to individuals

> though. Even

> > though that is surely an absolutely fundamental requirement, there is the

> wider public

> > health issue of an overview of the health needs in an area, which may not

> appear in a

> > traditional form of caseload. I think it is where that has gone awry,

> that the

> > numbers of HVs have been allowed to drift downwards so badly.

> >

> > There has always been a debate, too, about the meaning of the term

> 'caseload'. Is it

> > measured in terms of indexed children aged under five? Or does it include

> their

> > families? (if so, who counts as 'family'?) Or files in the filing

> cabinet? Or active

> > cases? Or is it closer to the idea of the GP caselist, with HVs having a

> > responsibility for people that they rarely see, but who know they can

> turn to the HV

> > if they need her? (GPs usually, I think, have 2,000 or even 3,000

> individuals on

> > their list). Is it about individuals, or something else? What about a

> geographic

> > area or a school or, bearing in mind Jan's fascinating description of her

> work, a

> > prison?

> >

> > I wonder if others, like me, worry about the often-expressed view that we

> should be

> > swapping 'caseloads' for 'public health' work? I do not want to suggest

> that we should

> > be ignoring that wider public health/community view, because I believe it

> is the

> > combination of individual plus community-wide work that is distinctive to

> health

> > visiting. It also happens to be what the evidence shows works best in

> terms of health

> > improvement. best wishes

> >

> >

> >

> > ruthngrant wrote:

> >

> > > I agree entirely , but I am sure that there are upper limits to the

> numbers of

> > > individuals (regardless of level of need) that one HV can relate to.

> Perhaps the

> > > poor staff in those areas lists have reached that limit.

> Would there be

> > > any value in profiling those individuals case loads - at least then

> service

> > > providers would know the upper limits/situations that should trigger

> emergency

> > > situations?

> > >

> > > Ruth

> > >

> > > Cowley wrote:

> > >

> > > > Sorry, I buried my response to Ruth's question at the end of a long

> message

> > > > (called opening the debate: because I think 'universal vs. selective'

> is such

> > > > an important issue), to which Woody has just responded. The points I

> was

> > > > making about the arithmetic of the spread of services applies here:

> numbers of

> > > > children/population do not equate to numbers of needs.

> > > >

> > > > best wishes

> > > >

> > > > Bidmead wrote:

> > > >

> > > > > I am talking about an inner London situation where the staffing

> levels are

> > > > > down 30%-50% in the localities and staff are carrying caseloads of

> 400-500

> > > > > families (not children) with high child protection and not enough

> social

> > > > > workers to cover children on the CP register. This was a year ago

> and I am

> > > > > aware that things are changing with the advent of the PCT. They

> certainly

> > > > > needed to.

> > > > >

> > > > >

> > > > >

> > > > > Re: RE: client perceptions of HV

> > > > > > >

> > > > > > > > Margaret/Chris/Ann/,

> > > > > > > > I am aware that I keep repeating myself, but I believe

> strongly that

> > > > > one

> > > > > > > of the

> > > > > > > > main strengths of health visiting is the fact that we work at

> the

> > > > > > > cross-roads of

> > > > > > > > the public health/medico/psycho/social services.We work in an

> > > > > independent

> > > > > > > style

> > > > > > > > that enables us to acknowledge complexities in a client's life

> and

> > > > > wait

> > > > > > > > patiently for that individual to arrive at a point were they

> are ready

> > > > > for

> > > > > > > > action. We are then in a knowing position to signpost and

> support as

> > > > > they

> > > > > > > make

> > > > > > > > what maybe a significant change for them but a microscopic

> change in a

> > > > > > > public

> > > > > > > > health perspective. That is the strength and subtlety of

> family public

> > > > > > > health as

> > > > > > > > delivered by health visitors. Oh, and yes, such patience,

> > > > > knowledge-base

> > > > > > > and

> > > > > > > > skill requires a top-class employee who deserves a good wage

> and

> > > > > working

> > > > > > > > conditions in a capitalist society.

> > > > > > > >

> > > > > > > > Ruth

> > > > > > > >

> >

> >

> >

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Posted
Posted

hi just testing

Re: RE: client perceptions of HV

,

I am in the delicious position where the boundaries you mention are

coterminous and in an

area where the group of health visitors are dynamic and have always

persisted(covertly for

some of the time!) in public health initiatives - particularly knowledge of

local

facilities and networking with other agencies. We are, therefore, well

placed now to move

ahead with most of the baseline work already undertaken.

However, as the funding is linked to evidence, and acceptable evidence in

public health

terms (RCTs) is not always available we are in a bit of a Catch 22 with our

community

initiatives.

Ruth

Cowley wrote:

> That is a good point Ruth and clients persistently tell us (even though

our paymasters

> do not always want to believe them) that personal relationships matter

enormously. I

> am not sure that health visiting is only about relating to individuals

though. Even

> though that is surely an absolutely fundamental requirement, there is the

wider public

> health issue of an overview of the health needs in an area, which may not

appear in a

> traditional form of caseload. I think it is where that has gone awry,

that the

> numbers of HVs have been allowed to drift downwards so badly.

>

> There has always been a debate, too, about the meaning of the term

'caseload'. Is it

> measured in terms of indexed children aged under five? Or does it include

their

> families? (if so, who counts as 'family'?) Or files in the filing

cabinet? Or active

> cases? Or is it closer to the idea of the GP caselist, with HVs having a

> responsibility for people that they rarely see, but who know they can

turn to the HV

> if they need her? (GPs usually, I think, have 2,000 or even 3,000

individuals on

> their list). Is it about individuals, or something else? What about a

geographic

> area or a school or, bearing in mind Jan's fascinating description of her

work, a

> prison?

>

> I wonder if others, like me, worry about the often-expressed view that we

should be

> swapping 'caseloads' for 'public health' work? I do not want to suggest

that we should

> be ignoring that wider public health/community view, because I believe it

is the

> combination of individual plus community-wide work that is distinctive to

health

> visiting. It also happens to be what the evidence shows works best in

terms of health

> improvement. best wishes

>

>

>

> ruthngrant wrote:

>

> > I agree entirely , but I am sure that there are upper limits to the

numbers of

> > individuals (regardless of level of need) that one HV can relate to.

Perhaps the

> > poor staff in those areas lists have reached that limit.

Would there be

> > any value in profiling those individuals case loads - at least then

service

> > providers would know the upper limits/situations that should trigger

emergency

> > situations?

> >

> > Ruth

> >

> > Cowley wrote:

> >

> > > Sorry, I buried my response to Ruth's question at the end of a long

message

> > > (called opening the debate: because I think 'universal vs. selective'

is such

> > > an important issue), to which Woody has just responded. The points I

was

> > > making about the arithmetic of the spread of services applies here:

numbers of

> > > children/population do not equate to numbers of needs.

> > >

> > > best wishes

> > >

> > > Bidmead wrote:

> > >

> > > > I am talking about an inner London situation where the staffing

levels are

> > > > down 30%-50% in the localities and staff are carrying caseloads of

400-500

> > > > families (not children) with high child protection and not enough

social

> > > > workers to cover children on the CP register. This was a year ago

and I am

> > > > aware that things are changing with the advent of the PCT. They

certainly

> > > > needed to.

> > > >

> > > >

> > > >

> > > > Re: RE: client perceptions of HV

> > > > > >

> > > > > > > Margaret/Chris/Ann/,

> > > > > > > I am aware that I keep repeating myself, but I believe

strongly that

> > > > one

> > > > > > of the

> > > > > > > main strengths of health visiting is the fact that we work at

the

> > > > > > cross-roads of

> > > > > > > the public health/medico/psycho/social services.We work in an

> > > > independent

> > > > > > style

> > > > > > > that enables us to acknowledge complexities in a client's life

and

> > > > wait

> > > > > > > patiently for that individual to arrive at a point were they

are ready

> > > > for

> > > > > > > action. We are then in a knowing position to signpost and

support as

> > > > they

> > > > > > make

> > > > > > > what maybe a significant change for them but a microscopic

change in a

> > > > > > public

> > > > > > > health perspective. That is the strength and subtlety of

family public

> > > > > > health as

> > > > > > > delivered by health visitors. Oh, and yes, such patience,

> > > > knowledge-base

> > > > > > and

> > > > > > > skill requires a top-class employee who deserves a good wage

and

> > > > working

> > > > > > > conditions in a capitalist society.

> > > > > > >

> > > > > > > Ruth

> > > > > > >

>

>

>

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Posted
Posted

For anyone wanting excellent training re: Health Care Records, try the Bond

Solon. The facilitator is Andy s, a qualified lawyer and a trust legal

advisor. We all fight over who is going to attend these training days! Tel 020

7253 7053 or www.bondsolon.com. Judy

Re: RE: client perceptions of HV

,

I am in the delicious position where the boundaries you mention are

coterminous and in an

area where the group of health visitors are dynamic and have always

persisted(covertly for

some of the time!) in public health initiatives - particularly knowledge of

local

facilities and networking with other agencies. We are, therefore, well

placed now to move

ahead with most of the baseline work already undertaken.

However, as the funding is linked to evidence, and acceptable evidence in

public health

terms (RCTs) is not always available we are in a bit of a Catch 22 with our

community

initiatives.

Ruth

Cowley wrote:

> That is a good point Ruth and clients persistently tell us (even though

our paymasters

> do not always want to believe them) that personal relationships matter

enormously. I

> am not sure that health visiting is only about relating to individuals

though. Even

> though that is surely an absolutely fundamental requirement, there is the

wider public

> health issue of an overview of the health needs in an area, which may not

appear in a

> traditional form of caseload. I think it is where that has gone awry,

that the

> numbers of HVs have been allowed to drift downwards so badly.

>

> There has always been a debate, too, about the meaning of the term

'caseload'. Is it

> measured in terms of indexed children aged under five? Or does it include

their

> families? (if so, who counts as 'family'?) Or files in the filing

cabinet? Or active

> cases? Or is it closer to the idea of the GP caselist, with HVs having a

> responsibility for people that they rarely see, but who know they can

turn to the HV

> if they need her? (GPs usually, I think, have 2,000 or even 3,000

individuals on

> their list). Is it about individuals, or something else? What about a

geographic

> area or a school or, bearing in mind Jan's fascinating description of her

work, a

> prison?

>

> I wonder if others, like me, worry about the often-expressed view that we

should be

> swapping 'caseloads' for 'public health' work? I do not want to suggest

that we should

> be ignoring that wider public health/community view, because I believe it

is the

> combination of individual plus community-wide work that is distinctive to

health

> visiting. It also happens to be what the evidence shows works best in

terms of health

> improvement. best wishes

>

>

>

> ruthngrant wrote:

>

> > I agree entirely , but I am sure that there are upper limits to the

numbers of

> > individuals (regardless of level of need) that one HV can relate to.

Perhaps the

> > poor staff in those areas lists have reached that limit.

Would there be

> > any value in profiling those individuals case loads - at least then

service

> > providers would know the upper limits/situations that should trigger

emergency

> > situations?

> >

> > Ruth

> >

> > Cowley wrote:

> >

> > > Sorry, I buried my response to Ruth's question at the end of a long

message

> > > (called opening the debate: because I think 'universal vs. selective'

is such

> > > an important issue), to which Woody has just responded. The points I

was

> > > making about the arithmetic of the spread of services applies here:

numbers of

> > > children/population do not equate to numbers of needs.

> > >

> > > best wishes

> > >

> > > Bidmead wrote:

> > >

> > > > I am talking about an inner London situation where the staffing

levels are

> > > > down 30%-50% in the localities and staff are carrying caseloads of

400-500

> > > > families (not children) with high child protection and not enough

social

> > > > workers to cover children on the CP register. This was a year ago

and I am

> > > > aware that things are changing with the advent of the PCT. They

certainly

> > > > needed to.

> > > >

> > > >

> > > >

> > > > Re: RE: client perceptions of HV

> > > > > >

> > > > > > > Margaret/Chris/Ann/,

> > > > > > > I am aware that I keep repeating myself, but I believe

strongly that

> > > > one

> > > > > > of the

> > > > > > > main strengths of health visiting is the fact that we work at

the

> > > > > > cross-roads of

> > > > > > > the public health/medico/psycho/social services.We work in an

> > > > independent

> > > > > > style

> > > > > > > that enables us to acknowledge complexities in a client's life

and

> > > > wait

> > > > > > > patiently for that individual to arrive at a point were they

are ready

> > > > for

> > > > > > > action. We are then in a knowing position to signpost and

support as

> > > > they

> > > > > > make

> > > > > > > what maybe a significant change for them but a microscopic

change in a

> > > > > > public

> > > > > > > health perspective. That is the strength and subtlety of

family public

> > > > > > health as

> > > > > > > delivered by health visitors. Oh, and yes, such patience,

> > > > knowledge-base

> > > > > > and

> > > > > > > skill requires a top-class employee who deserves a good wage

and

> > > > working

> > > > > > > conditions in a capitalist society.

> > > > > > >

> > > > > > > Ruth

> > > > > > >

>

>

>

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Posted
Posted

Ruth, I do not have a problem with the actual emails but they come with some

very odd attachments which are not referred to in the email so I assume that

they are not meant to be sent and do not open them just in case. Do you

know that this happens, I wonder?

Re: RE: client perceptions of HV

> > > > > > > > >

> > > > > > > > > > Margaret/Chris/Ann/,

> > > > > > > > > > I am aware that I keep repeating myself, but I believe

> > > strongly that

> > > > > > > one

> > > > > > > > > of the

> > > > > > > > > > main strengths of health visiting is the fact that we

work at

> > > the

> > > > > > > > > cross-roads of

> > > > > > > > > > the public health/medico/psycho/social services.We work

in an

> > > > > > > independent

> > > > > > > > > style

> > > > > > > > > > that enables us to acknowledge complexities in a

client's life

> > > and

> > > > > > > wait

> > > > > > > > > > patiently for that individual to arrive at a point were

they

> > > are ready

> > > > > > > for

> > > > > > > > > > action. We are then in a knowing position to signpost

and

> > > support as

> > > > > > > they

> > > > > > > > > make

> > > > > > > > > > what maybe a significant change for them but a

microscopic

> > > change in a

> > > > > > > > > public

> > > > > > > > > > health perspective. That is the strength and subtlety of

> > > family public

> > > > > > > > > health as

> > > > > > > > > > delivered by health visitors. Oh, and yes, such

patience,

> > > > > > > knowledge-base

> > > > > > > > > and

> > > > > > > > > > skill requires a top-class employee who deserves a good

wage

> > > and

> > > > > > > working

> > > > > > > > > > conditions in a capitalist society.

> > > > > > > > > >

> > > > > > > > > > Ruth

> > > > > > > > > >

> > > >

> > > >

> > > >

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Posted
Posted

If you can give me SPECIFIC examples of inner cities..I can take this issue

to the MH taskforce.

It is crucial that I do, since the EPNDS and perinatal depression are key

areas of identified need and action.

Manning

www.primhe.org

www.depressionalliance.org

Re: RE: client perceptions of HV

Ruth

It is really good to hear that someone is workingin this way within health

visiting and has the time and space to do so.

In the inner cities the health visitors are saying they do not even have

time to follow up on EPNDS so anything more would be out of the question.

Also the resources are just not there to follow up the identified need if it

bcomes to much for them to cope with which providesd another reason not to

search.

I know it is part of the mind set which has come about for a variety of

reasons but without guidance and development and the support of the PCt it

is extremely difficult to make a change.

Is it any wander Sure Start suggests we are not delivering what clients

want.

Margaret

Margaret

Re: RE: client perceptions of HV

> > > > > > > >

> > > > > > > > > Margaret/Chris/Ann/,

> > > > > > > > > I am aware that I keep repeating myself, but I believe

> > strongly that

> > > > > > one

> > > > > > > > of the

> > > > > > > > > main strengths of health visiting is the fact that we work

at

> > the

> > > > > > > > cross-roads of

> > > > > > > > > the public health/medico/psycho/social services.We work in

an

> > > > > > independent

> > > > > > > > style

> > > > > > > > > that enables us to acknowledge complexities in a client's

life

> > and

> > > > > > wait

> > > > > > > > > patiently for that individual to arrive at a point were

they

> > are ready

> > > > > > for

> > > > > > > > > action. We are then in a knowing position to signpost and

> > support as

> > > > > > they

> > > > > > > > make

> > > > > > > > > what maybe a significant change for them but a microscopic

> > change in a

> > > > > > > > public

> > > > > > > > > health perspective. That is the strength and subtlety of

> > family public

> > > > > > > > health as

> > > > > > > > > delivered by health visitors. Oh, and yes, such patience,

> > > > > > knowledge-base

> > > > > > > > and

> > > > > > > > > skill requires a top-class employee who deserves a good

wage

> > and

> > > > > > working

> > > > > > > > > conditions in a capitalist society.

> > > > > > > > >

> > > > > > > > > Ruth

> > > > > > > > >

> > >

> > >

> > >

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Posted
Posted

Dear

Thank you indeed for this.

Chris.

Re: RE: client perceptions of HV

,

I am in the delicious position where the boundaries you mention are

coterminous and in an

area where the group of health visitors are dynamic and have always

persisted(covertly for

some of the time!) in public health initiatives - particularly knowledge of

local

facilities and networking with other agencies. We are, therefore, well

placed now to move

ahead with most of the baseline work already undertaken.

However, as the funding is linked to evidence, and acceptable evidence in

public health

terms (RCTs) is not always available we are in a bit of a Catch 22 with our

community

initiatives.

Ruth

Cowley wrote:

> That is a good point Ruth and clients persistently tell us (even though

our paymasters

> do not always want to believe them) that personal relationships matter

enormously. I

> am not sure that health visiting is only about relating to individuals

though. Even

> though that is surely an absolutely fundamental requirement, there is the

wider public

> health issue of an overview of the health needs in an area, which may not

appear in a

> traditional form of caseload. I think it is where that has gone awry,

that the

> numbers of HVs have been allowed to drift downwards so badly.

>

> There has always been a debate, too, about the meaning of the term

'caseload'. Is it

> measured in terms of indexed children aged under five? Or does it include

their

> families? (if so, who counts as 'family'?) Or files in the filing

cabinet? Or active

> cases? Or is it closer to the idea of the GP caselist, with HVs having a

> responsibility for people that they rarely see, but who know they can

turn to the HV

> if they need her? (GPs usually, I think, have 2,000 or even 3,000

individuals on

> their list). Is it about individuals, or something else? What about a

geographic

> area or a school or, bearing in mind Jan's fascinating description of her

work, a

> prison?

>

> I wonder if others, like me, worry about the often-expressed view that we

should be

> swapping 'caseloads' for 'public health' work? I do not want to suggest

that we should

> be ignoring that wider public health/community view, because I believe it

is the

> combination of individual plus community-wide work that is distinctive to

health

> visiting. It also happens to be what the evidence shows works best in

terms of health

> improvement. best wishes

>

>

>

> ruthngrant wrote:

>

> > I agree entirely , but I am sure that there are upper limits to the

numbers of

> > individuals (regardless of level of need) that one HV can relate to.

Perhaps the

> > poor staff in those areas lists have reached that limit.

Would there be

> > any value in profiling those individuals case loads - at least then

service

> > providers would know the upper limits/situations that should trigger

emergency

> > situations?

> >

> > Ruth

> >

> > Cowley wrote:

> >

> > > Sorry, I buried my response to Ruth's question at the end of a long

message

> > > (called opening the debate: because I think 'universal vs. selective'

is such

> > > an important issue), to which Woody has just responded. The points I

was

> > > making about the arithmetic of the spread of services applies here:

numbers of

> > > children/population do not equate to numbers of needs.

> > >

> > > best wishes

> > >

> > > Bidmead wrote:

> > >

> > > > I am talking about an inner London situation where the staffing

levels are

> > > > down 30%-50% in the localities and staff are carrying caseloads of

400-500

> > > > families (not children) with high child protection and not enough

social

> > > > workers to cover children on the CP register. This was a year ago

and I am

> > > > aware that things are changing with the advent of the PCT. They

certainly

> > > > needed to.

> > > >

> > > >

> > > >

> > > > Re: RE: client perceptions of HV

> > > > > >

> > > > > > > Margaret/Chris/Ann/,

> > > > > > > I am aware that I keep repeating myself, but I believe

strongly that

> > > > one

> > > > > > of the

> > > > > > > main strengths of health visiting is the fact that we work at

the

> > > > > > cross-roads of

> > > > > > > the public health/medico/psycho/social services.We work in an

> > > > independent

> > > > > > style

> > > > > > > that enables us to acknowledge complexities in a client's life

and

> > > > wait

> > > > > > > patiently for that individual to arrive at a point were they

are ready

> > > > for

> > > > > > > action. We are then in a knowing position to signpost and

support as

> > > > they

> > > > > > make

> > > > > > > what maybe a significant change for them but a microscopic

change in a

> > > > > > public

> > > > > > > health perspective. That is the strength and subtlety of

family public

> > > > > > health as

> > > > > > > delivered by health visitors. Oh, and yes, such patience,

> > > > knowledge-base

> > > > > > and

> > > > > > > skill requires a top-class employee who deserves a good wage

and

> > > > working

> > > > > > > conditions in a capitalist society.

> > > > > > >

> > > > > > > Ruth

> > > > > > >

>

>

>

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Posted
Posted

Chris

My understandingis that it is most of the London inner/outer city areas

where there is no what we would call real Hv servcie because of demand,

staff shortages and really lack of support as well as poor morale.

the Kings Fund have just published a documet on Public Health in London

which says something similar and particularly draws attention to the

shortage of HVs and there is also that report called Health in London from

the London Health Commision

Margaret

Re: RE: client perceptions of HV

> > > > > > > > >

> > > > > > > > > > Margaret/Chris/Ann/,

> > > > > > > > > > I am aware that I keep repeating myself, but I believe

> > > strongly that

> > > > > > > one

> > > > > > > > > of the

> > > > > > > > > > main strengths of health visiting is the fact that we

work

> at

> > > the

> > > > > > > > > cross-roads of

> > > > > > > > > > the public health/medico/psycho/social services.We work

in

> an

> > > > > > > independent

> > > > > > > > > style

> > > > > > > > > > that enables us to acknowledge complexities in a

client's

> life

> > > and

> > > > > > > wait

> > > > > > > > > > patiently for that individual to arrive at a point were

> they

> > > are ready

> > > > > > > for

> > > > > > > > > > action. We are then in a knowing position to signpost

and

> > > support as

> > > > > > > they

> > > > > > > > > make

> > > > > > > > > > what maybe a significant change for them but a

microscopic

> > > change in a

> > > > > > > > > public

> > > > > > > > > > health perspective. That is the strength and subtlety of

> > > family public

> > > > > > > > > health as

> > > > > > > > > > delivered by health visitors. Oh, and yes, such

patience,

> > > > > > > knowledge-base

> > > > > > > > > and

> > > > > > > > > > skill requires a top-class employee who deserves a good

> wage

> > > and

> > > > > > > working

> > > > > > > > > > conditions in a capitalist society.

> > > > > > > > > >

> > > > > > > > > > Ruth

> > > > > > > > > >

> > > >

> > > >

> > > >

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Posted
Posted

Margaret

Thanks for this..unfortunately general studies will be familiar to the

Taskforce.

Louis Appleby wnats and needs specific examples from specific

people...because Govt will always just

respond to docs like these by saying that they have just injected bla bla

billions etc..ie they respond at top level.

It does not force them into detail. Also very helpful to have examples of

where people know that

moneys for HV (eg in mental health..especally peri-natal depression ) are

not getting to the front-line.

Chris.

Re: RE: client perceptions of HV

Chris

My understandingis that it is most of the London inner/outer city areas

where there is no what we would call real Hv servcie because of demand,

staff shortages and really lack of support as well as poor morale.

the Kings Fund have just published a documet on Public Health in London

which says something similar and particularly draws attention to the

shortage of HVs and there is also that report called Health in London from

the London Health Commision

Margaret

Re: RE: client perceptions of HV

> > > > > > > > >

> > > > > > > > > > Margaret/Chris/Ann/,

> > > > > > > > > > I am aware that I keep repeating myself, but I believe

> > > strongly that

> > > > > > > one

> > > > > > > > > of the

> > > > > > > > > > main strengths of health visiting is the fact that we

work

> at

> > > the

> > > > > > > > > cross-roads of

> > > > > > > > > > the public health/medico/psycho/social services.We work

in

> an

> > > > > > > independent

> > > > > > > > > style

> > > > > > > > > > that enables us to acknowledge complexities in a

client's

> life

> > > and

> > > > > > > wait

> > > > > > > > > > patiently for that individual to arrive at a point were

> they

> > > are ready

> > > > > > > for

> > > > > > > > > > action. We are then in a knowing position to signpost

and

> > > support as

> > > > > > > they

> > > > > > > > > make

> > > > > > > > > > what maybe a significant change for them but a

microscopic

> > > change in a

> > > > > > > > > public

> > > > > > > > > > health perspective. That is the strength and subtlety of

> > > family public

> > > > > > > > > health as

> > > > > > > > > > delivered by health visitors. Oh, and yes, such

patience,

> > > > > > > knowledge-base

> > > > > > > > > and

> > > > > > > > > > skill requires a top-class employee who deserves a good

> wage

> > > and

> > > > > > > working

> > > > > > > > > > conditions in a capitalist society.

> > > > > > > > > >

> > > > > > > > > > Ruth

> > > > > > > > > >

> > > >

> > > >

> > > >

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Posted
Posted

ditto.Ann

>From: " Bidmead"

>Reply- >

>Subject: Re: RE: client perceptions of HV >Date: Wed, 24 Apr 2002 08:45:12 +0100 > >Ruth, I do not have a problem with the actual emails but they come with some >very odd attachments which are not referred to in the email so I assume that >they are not meant to be sent and do not open them just in case. Do you >know that this happens, I wonder? > > Re: RE: client perceptions of HV > > > > > > > > > > > > > > > > > > > > > Margaret/Chris/Ann/, > > > > > > > > > > > I am aware that I keep repeating myself, but I believe > > > > strongly that > > > > > > > > one > > > > > > > > > > of the > > > > > > > > > > > main strengths of health visiting is the fact that we >work at > > > > the > > > > > > > > > > cross-roads of > > > > > > > > > > > the public health/medico/psycho/social services.We work >in an > > > > > > > > independent > > > > > > > > > > style > > > > > > > > > > > that enables us to acknowledge complexities in a >client's life > > > > and > > > > > > > > wait > > > > > > > > > > > patiently for that individual to arrive at a point were >they > > > > are ready > > > > > > > > for > > > > > > > > > > > action. We are then in a knowing position to signpost >and > > > > support as > > > > > > > > they > > > > > > > > > > make > > > > > > > > > > > what maybe a significant change for them but a >microscopic > > > > change in a > > > > > > > > > > public > > > > > > > > > > > health perspective. That is the strength and subtlety of > > > > family public > > > > > > > > > > health as > > > > > > > > > > > delivered by health visitors. Oh, and yes, such >patience, > > > > > > > > knowledge-base > > > > > > > > > > and > > > > > > > > > > > skill requires a top-class employee who deserves a good >wage > > > > and > > > > > > > > working > > > > > > > > > > > conditions in a capitalist society. > > > > > > > > > > > > > > > > > > > > > > Ruth > > > > > > > > > > > > > > > > > > > > > > > > > >

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