Re: I thought people might be interested in this.

[Guest guest]

We always see the families at the ante natal visit and we are looking to

include a second ante natal visit. We consider ante natal contact a number

one priority. We found that our midwife colleagues maintained contact quite

often for longer than 14 days and that our visits overlapped. This was

duplication of services and in that we communicate with the midwives daily

simply discussed it with them so it grew if you like. We DO need to evaluate

client satisfaction but we have only been working in this way for afew

months.

As for who decides, it is a partnership with the family and the

midwife/health visitor that leads the way.

I thought people might be interested in

> >this.

> >

> >

> > Parents warned about " unhelpful teaching "

> > Parents who teach their pre-school children to read, write and

> >add could be setting them up for mental health problems later in life,

the

> >Royal College of Paediatrics and Child Health says. A report issued today

> >(04/04/03) encourages patients to interact with their infants through

> >informal play, but warns against adopting a formal teaching approach. The

> >study investigates why so many children have emotional and behavioural

> >problems at a time when they are healthier and better educated than ever.

> >It blames " unhelpful parenting practices " and a lack of understanding

among

> >parents of child development.

> > (The Times 04/04/03; p.19)

> >

> > © HMG Worldwide 2003

> > http://www.health-news.co.uk/

> >

> >

> > Babies of divorced parents suffer

> >

> > " Babies forced to spend nights in the separate homes of

divorced

> >or separated parents often suffer emotional and physical anguish,

according

> >to new research. Such infants have more tantrums, develop eating and

> >sleeping disorders, and exhibit distress through symptoms such as raised

> >heartbeats. They also fail to identify their mothers as a source of

comfort

> >because they are confused by her regular absences. The findings were made

> >in the world's first study of how infants' attachment to their parents is

> >affected by overnight stays.

> > (The Daily Telegraph 04/04/03; p.13)

> >

> > © HMG Worldwide 2003

> > http://www.health-news.co.uk/

> >

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

I am sorry but I will be out of the office from Friday 11 April 2003 until

Wednesday 23 April

2003.

[Guest guest]

Hi

I will not that in my diary but am actually the other side of London in the morning so will get back to you nearer the time

Margaret

I thought people might be interested in this.

Parents warned about “unhelpful teaching”

Parents who teach their pre-school children to read, write and add could be setting them up for mental health problems later in life, the Royal College of Paediatrics and Child Health says. A report issued today (04/04/03) encourages patients to interact with their infants through informal play, but warns against adopting a formal teaching approach. The study investigates why so many children have emotional and behavioural problems at a time when they are healthier and better educated than ever. It blames “unhelpful parenting practices” and a lack of understanding among parents of child development.(The Times 04/04/03; p.19)© HMG Worldwide 2003http://www.health-news.co.uk/

Babies of divorced parents suffer

”Babies forced to spend nights in the separate homes of divorced or separated parents often suffer emotional and physical anguish, according to new research. Such infants have more tantrums, develop eating and sleeping disorders, and exhibit distress through symptoms such as raised heartbeats. They also fail to identify their mothers as a source of comfort because they are confused by her regular absences. The findings were made in the world’s first study of how infants’ attachment to their parents is affected by overnight stays.(The Daily Telegraph 04/04/03; p.13)© HMG Worldwide 2003http://www.health-news.co.uk/

[Guest guest]

Hi Helen

My comments about the traditional birth visit reflect a concern I have that for some HVs and in some PCTs the birth visit has become a tick box exercise to fill in the forms rather than as described by some SENATE members as a very positive experience for the families and themselves. It is often in many places the only home visit a family gets due to staff shortages and I guess for some HVs it is now a task rather than a pleasure.

It is a long time since I was in practice and I know we have a lot more paper work than then but for me the new birth visit and the ante natal contacts which we made then formed a real basis for the relationship with the family and any work undertaken. I am not seeing that now in many places and when you suggest HVs may like to consider things like sharing the 28 days post delivery with the midwife or not going in until that contact has finished - sacrilage and not allowed!

I agree with you that midwifes should be visiting up to 28 days that is in statute but the birth visit is not.

I guess what I am saying is - are we really addressing and meeting families needs and often when I ask that question the answer I come up with is NO.

You are so right about the gap from 3- 5 years - I have been doing a lot of work across school health services recently and there is a major issue of an abandoned age group.

the discussion around this area has been very helpful so if others have thoughts - do let us know them

Margaret

I thought people might be interested in this.

Parents warned about “unhelpful teaching”

Parents who teach their pre-school children to read, write and add could be setting them up for mental health problems later in life, the Royal College of Paediatrics and Child Health says. A report issued today (04/04/03) encourages patients to interact with their infants through informal play, but warns against adopting a formal teaching approach. The study investigates why so many children have emotional and behavioural problems at a time when they are healthier and better educated than ever. It blames “unhelpful parenting practices” and a lack of understanding among parents of child development.(The Times 04/04/03; p.19)© HMG Worldwide 2003http://www.health-news.co.uk/

Babies of divorced parents suffer

”Babies forced to spend nights in the separate homes of divorced or separated parents often suffer emotional and physical anguish, according to new research. Such infants have more tantrums, develop eating and sleeping disorders, and exhibit distress through symptoms such as raised heartbeats. They also fail to identify their mothers as a source of comfort because they are confused by her regular absences. The findings were made in the world’s first study of how infants’ attachment to their parents is affected by overnight stays.(The Daily Telegraph 04/04/03; p.13)© HMG Worldwide 2003http://www.health-news.co.uk/

[Guest guest]

I am sorry but I will be out of the office from Friday 11 April 2003 until

Wednesday 23 April

2003.

[Guest guest]

Hi Betty

I too trained in the early 70's but in Cambridgeshire we were less public health

focused than you were, but we did a lot of group work and health promotion

activities in pre-schools and schools. The problem was lack of evidence to

support the effectiveness of what was being done to present to employers, and

hence disinvestment in the 1990s. I agree entirely with what you're saying but

just working in that way is not enough, the evidence of effectiveness has to be

disseminated in a research based way otherwise no one knows about it, least of

all the employers.

Penny

Re: I thought people might be interested in this.

I have been following this correspondence with a great degree of sadness as it

provides yet

another example to me of how much can be lost over time if as professional

practitioners we do

not have the vision and assertiveness to fight and make the case for what we

understand to be

good practice. I write as someone with regrets that I have not been as vocal as

I now

understand I needed to have been.

Recent attention to " modernising " the role of the health visitor similarly

grieves me. In 1970

I began to work as a young and inexperienced health visitor. I was employed by

the local

authority, and my nearest and only manager (the Superintendent Health Visitor!)

was 40 miles

away from my clinic base. From the point of view of protecting the public I had

a level of

freedom from supervision and monitoring which would rightly be unacceptable

today. However,

that freedom also allowed me the flexibility and autonomy to attempt practice as

I had been

taught.

What follows is an attempt to describe some of the values, priorities, and

practice of a young

and not very remarkable HV some 30+ years ago.

33 years ago my colleague and I developed antenatal classes in collaboration

with the local

community midwife, a client who was a qualified physiotherapist, a Marriage

Guidance (as it

then was) counsellor who wanted to do positive preventive work, and a GP with a

particular

commitment to obstetrics. Our classes were informal, used a variety of teaching

strategies,

and were increasingly client led. We involved fathers and indeed any

" significant others "

including grandmothers on occasion. The gains postnatally were evident in how

many of those

who came to the classes approached the trials and tribulations of becoming

parents, in the

informal support groups which developed out of the classes, in the collaboration

between

different professionals, and not least in the continuity of care which clients

felt they

experienced. We hadn't heard of partnership, interprofessional collaboration,

client-centred

practice, healthy alliances, flexible ways of working, - but we understood that

all those

things were an intrinsic part of what health visiting was all about.

We also held early evening drop-in group sessions in early pregnancy for working

mothers-to-be

who could stop off for a drink and an informal chat, and this strategy hugely

increased our

uptake of the main series of classes.

The attitude of our employer was essentially benevolently hands-off. Evening

work was

compensated by time in lieu, which we found almost more useful than extra cash.

So far as the birth visit was concerned, it was not often the first contact, as

we also

routinely paid at least one antenatal visit. We knew that those earliest

contacts were most

importantly about building the foundations of a meaningful and effective working

relationship

with each family, establishing our street cred. with clients, and that from the

start the

client's agenda was as important as our own. Antenatal contact and visits gave

me Having

qualified as a health visitor who then worked as a community midwife before

practising as a

health visitor, I didn't experience great dilemmas about overlap in visiting.

What was far

more important was firstly having a clear reason for visiting as a health

visitor which didn't

duplicate what the midwife was doing and secondly investing in good working

relationships with

the midwives so that neither professional group felt undermined by the other.

I had a large caseload in a new town - mainly families dislocated from their

family networks

and areas of origin, who came to this area for work. I and my colleagues lacked

adequate

preparation for identifying and dealing with child protection and domestic

violence. However,

from the outset we were committed to the notion of working for the long term

futures of our

clients and placed great importance on sufficient effort and input to build

valued

relationships with clients early on in our contact with them. Sometimes that was

achieved by

sustained home visiting and sometimes through informal group work with small

groups. Without

doubt this was not uncommonly to the detriment of routine contacts in the home

later on, but

at least many clients remembered us and contacted us in times of need because of

their early

experiences of us. Then as now there was the problem of whether a universal

service was

anything more than a cheerful fantasy - but a single contact at a birth visit

would have been

seen as meaningless.

I became aware of a local need amongst the " well " elderly (although I had never

heard of needs

assessment!) - living alone, isolated, on low income. I was told they were

" unclubbable " and

that efforts to set up a lunch club had foundered. I took advice from a local

WRVS worker,

recruited 12 " well " elderly as a team, and after 12 months was able to begin a

club on local

church premises which is still running today after more than 30 years and long

after I left

the area. I learned how to find pump priming funding, how to build the team's

confidence in

their ability, and the challenges of recruiting a leader/organiser. We hired a

bus from a

local voluntary group to bring people who were wheelchair bound, and I found a

retired lorry

driver to be the regular driver/club handyman. would not only transport

members, but do

fixing jobs in members' homes - on one occasion an elderly woman was in tears

because her bed

had collapsed, and by teatime had put it right. I made sure club

boundaries were

blurred. If someone crippled with osteoarthritis could peel a few potatoes, she

could see

herself as a provider rather than a consumer. The woman who took the money at

the door also

knew who was ill or needed help - and later, when she was terminally ill with

cancer club

members came to her aid and support. I deliberately recruited couples as well as

the single

and isolated, and the former often brought life and stimulus into the group.

Then when a

partner died the club was there for the one who was left. I hadn't heard of a

" special " public

health approach to practice or of community development. Public health and

community

development were simply and intrinsically what health visiting was about and

this was how they

were translated into everyday working.

When an insanitary local rubbish tip near to the homes of young families needed

closing I

joined with local teachers, householders and other agencies to fight

successfully for the

closure. When the company constructing the large new town development left

nowhere for

children to play safely I joined other agencies in lobbying, again successfully,

for some

redrafting of the plans.

The point I am trying to make is that I was not unusual, and that those with

whom I worked all

understood that these activities were as much a part of what health visiting was

about as the

other activities which Senate contributors have recently been describing as

" traditional " . It

wasn't " better in the good old days " - although the context was different there

was as much

scope for very poor practice as there is today, and there were many of the same

problems as

today which are still unresolved. Health visitors were a diverse bunch of

individuals, but

there was one thing which was very different then from now.Health visitors had a

strong sense

of what it was to be a health visitor which united them solidly. They might not

have been any

better then than now at articulating exactly what a health visitor is, but when

in 1972 the

Briggs Report proposed the title of " family health sister " and began the process

by which

health visiting was ultimately drawn under the statutory control of nursing,

health visitors

UK wide were vociferous and pretty united in opposition. My sadness today

includes the

awareness that as a group health visitors are more fragmented and uncertain as

to how they

regard themselves, and more willing to accept without question the right of

civil servants,

MPs, and non-health visiting managers to tell them what they are.

Health visiting began as a public health activity, has its roots in the need to

reconcile

social, political, environmental, and individual factors which affect the

quality of people's

lives and health, and hasn't essentially changed in this respect. It begins with

the

individual and the messiness of individual differences and diversity. Therefore

without home

visiting it cannot be effective. But it sees the individual's needs as only

being fully

understood in the context of the family, the local population, the community and

the wider

society. If what we are doing has departed too far from this, it might be

worthwhile, but it

isn't health visiting.

Betty

[Guest guest]

I am sorry but I will be out of the office from Friday 11 April 2003 until

Wednesday 23 April

2003.

[Guest guest]

That would be brilliant - enjoy your hols

Ann

I thought people might be interested in this.

Parents warned about “unhelpful teaching”

Parents who teach their pre-school children to read, write and add could be setting them up for mental health problems later in life, the Royal College of Paediatrics and Child Health says. A report issued today (04/04/03) encourages patients to interact with their infants through informal play, but warns against adopting a formal teaching approach. The study investigates why so many children have emotional and behavioural problems at a time when they are healthier and better educated than ever. It blames “unhelpful parenting practices” and a lack of understanding among parents of child development.(The Times 04/04/03; p.19)© HMG Worldwide 2003http://www.health-news.co.uk/

Babies of divorced parents suffer

”Babies forced to spend nights in the separate homes of divorced or separated parents often suffer emotional and physical anguish, according to new research. Such infants have more tantrums, develop eating and sleeping disorders, and exhibit distress through symptoms such as raised heartbeats. They also fail to identify their mothers as a source of comfort because they are confused by her regular absences. The findings were made in the world’s first study of how infants’ attachment to their parents is affected by overnight stays.(The Daily Telegraph 04/04/03; p.13)© HMG Worldwide 2003http://www.health-news.co.uk/

[Guest guest]

I am sorry but I will be out of the office from Friday 11 April 2003 until

Wednesday 23 April

2003.

[Guest guest]

Maybe that's the next step!!

Re: I thought people might be interested in this.

I have been following this correspondence with a great degree of sadness as it provides yetanother example to me of how much can be lost over time if as professional practitioners we donot have the vision and assertiveness to fight and make the case for what we understand to begood practice. I write as someone with regrets that I have not been as vocal as I nowunderstand I needed to have been.Recent attention to "modernising" the role of the health visitor similarly grieves me. In 1970I began to work as a young and inexperienced health visitor. I was employed by the localauthority, and my nearest and only manager (the Superintendent Health Visitor!) was 40 milesaway from my clinic base. From the point of view of protecting the public I had a level offreedom from supervision and monitoring which would rightly be unacceptable today. However,that freedom also allowed me the flexibility and autonomy to attempt practice as I had beentaught.What follows is an attempt to describe some of the values, priorities, and practice of a youngand not very remarkable HV some 30+ years ago. 33 years ago my colleague and I developed antenatal classes in collaboration with the localcommunity midwife, a client who was a qualified physiotherapist, a Marriage Guidance (as itthen was) counsellor who wanted to do positive preventive work, and a GP with a particularcommitment to obstetrics. Our classes were informal, used a variety of teaching strategies,and were increasingly client led. We involved fathers and indeed any "significant others"including grandmothers on occasion. The gains postnatally were evident in how many of thosewho came to the classes approached the trials and tribulations of becoming parents, in theinformal support groups which developed out of the classes, in the collaboration betweendifferent professionals, and not least in the continuity of care which clients felt theyexperienced. We hadn't heard of partnership, interprofessional collaboration, client-centredpractice, healthy alliances, flexible ways of working, - but we understood that all thosethings were an intrinsic part of what health visiting was all about.We also held early evening drop-in group sessions in early pregnancy for working mothers-to-bewho could stop off for a drink and an informal chat, and this strategy hugely increased ouruptake of the main series of classes.The attitude of our employer was essentially benevolently hands-off. Evening work wascompensated by time in lieu, which we found almost more useful than extra cash.So far as the birth visit was concerned, it was not often the first contact, as we alsoroutinely paid at least one antenatal visit. We knew that those earliest contacts were mostimportantly about building the foundations of a meaningful and effective working relationshipwith each family, establishing our street cred. with clients, and that from the start theclient's agenda was as important as our own. Antenatal contact and visits gave me Havingqualified as a health visitor who then worked as a community midwife before practising as ahealth visitor, I didn't experience great dilemmas about overlap in visiting. What was farmore important was firstly having a clear reason for visiting as a health visitor which didn'tduplicate what the midwife was doing and secondly investing in good working relationships withthe midwives so that neither professional group felt undermined by the other.I had a large caseload in a new town - mainly families dislocated from their family networksand areas of origin, who came to this area for work. I and my colleagues lacked adequatepreparation for identifying and dealing with child protection and domestic violence. However,from the outset we were committed to the notion of working for the long term futures of ourclients and placed great importance on sufficient effort and input to build valuedrelationships with clients early on in our contact with them. Sometimes that was achieved bysustained home visiting and sometimes through informal group work with small groups. Withoutdoubt this was not uncommonly to the detriment of routine contacts in the home later on, butat least many clients remembered us and contacted us in times of need because of their earlyexperiences of us. Then as now there was the problem of whether a universal service wasanything more than a cheerful fantasy - but a single contact at a birth visit would have beenseen as meaningless.I became aware of a local need amongst the "well" elderly (although I had never heard of needsassessment!) - living alone, isolated, on low income. I was told they were "unclubbable" andthat efforts to set up a lunch club had foundered. I took advice from a local WRVS worker,recruited 12 "well" elderly as a team, and after 12 months was able to begin a club on localchurch premises which is still running today after more than 30 years and long after I leftthe area. I learned how to find pump priming funding, how to build the team's confidence intheir ability, and the challenges of recruiting a leader/organiser. We hired a bus from alocal voluntary group to bring people who were wheelchair bound, and I found a retired lorrydriver to be the regular driver/club handyman. would not only transport members, but dofixing jobs in members' homes - on one occasion an elderly woman was in tears because her bedhad collapsed, and by teatime had put it right. I made sure club boundaries wereblurred. If someone crippled with osteoarthritis could peel a few potatoes, she could seeherself as a provider rather than a consumer. The woman who took the money at the door alsoknew who was ill or needed help - and later, when she was terminally ill with cancer clubmembers came to her aid and support. I deliberately recruited couples as well as the singleand isolated, and the former often brought life and stimulus into the group. Then when apartner died the club was there for the one who was left. I hadn't heard of a "special" publichealth approach to practice or of community development. Public health and communitydevelopment were simply and intrinsically what health visiting was about and this was how theywere translated into everyday working.When an insanitary local rubbish tip near to the homes of young families needed closing Ijoined with local teachers, householders and other agencies to fight successfully for theclosure. When the company constructing the large new town development left nowhere forchildren to play safely I joined other agencies in lobbying, again successfully, for someredrafting of the plans.The point I am trying to make is that I was not unusual, and that those with whom I worked allunderstood that these activities were as much a part of what health visiting was about as theother activities which Senate contributors have recently been describing as "traditional". Itwasn't "better in the good old days" - although the context was different there was as muchscope for very poor practice as there is today, and there were many of the same problems astoday which are still unresolved. Health visitors were a diverse bunch of individuals, butthere was one thing which was very different then from now.Health visitors had a strong senseof what it was to be a health visitor which united them solidly. They might not have been anybetter then than now at articulating exactly what a health visitor is, but when in 1972 theBriggs Report proposed the title of "family health sister" and began the process by whichhealth visiting was ultimately drawn under the statutory control of nursing, health visitorsUK wide were vociferous and pretty united in opposition. My sadness today includes theawareness that as a group health visitors are more fragmented and uncertain as to how theyregard themselves, and more willing to accept without question the right of civil servants,MPs, and non-health visiting managers to tell them what they are. Health visiting began as a public health activity, has its roots in the need to reconcilesocial, political, environmental, and individual factors which affect the quality of people'slives and health, and hasn't essentially changed in this respect. It begins with theindividual and the messiness of individual differences and diversity. Therefore without homevisiting it cannot be effective. But it sees the individual's needs as only being fullyunderstood in the context of the family, the local population, the community and the widersociety. If what we are doing has departed too far from this, it might be worthwhile, but itisn't health visiting.Betty

[Guest guest]

I am sorry but I will be out of the office from Friday 11 April 2003 until

Wednesday 23 April

2003.

[Guest guest]

Taht could be a really useful resource - thank you

I thought people might be interested in this.

Parents warned about "unhelpful teaching"

Parents who teach their pre-school children to read, write and add could be setting them up for mental health problems later in life, the Royal College of Paediatrics and Child Health says. A report issued today (04/04/03) encourages patients to interact with their infants through informal play, but warns against adopting a formal teaching approach. The study investigates why so many children have emotional and behavioural problems at a time when they are healthier and better educated than ever. It blames "unhelpful parenting practices" and a lack of understanding among parents of child development.(The Times 04/04/03; p.19)© HMG Worldwide 2003http://www.health-news.co.uk/

Babies of divorced parents suffer

"Babies forced to spend nights in the separate homes of divorced or separated parents often suffer emotional and physical anguish, according to new research. Such infants have more tantrums, develop eating and sleeping disorders, and exhibit distress through symptoms such as raised heartbeats. They also fail to identify their mothers as a source of comfort because they are confused by her regular absences. The findings were made in the world's first study of how infants' attachment to their parents is affected by overnight stays.(The Daily Telegraph 04/04/03; p.13)© HMG Worldwide 2003http://www.health-news.co.uk/

[Guest guest]

I am sorry but I will be out of the office from Friday 11 April 2003 until

Wednesday 23 April

2003.

[Guest guest]

I think feeling able to is the key here. I've been reading so much about conflicting agendas of the PCT's being driven by government obsession with outcomes which are so focussed on the medical model and which do not fit with our only too positive outcomes. We have to continue challenging that very narrow focus on health

Ann

Re: I thought people might be interested in this.> I have been following this correspondence with a great degree of sadnessas it provides yet> another example to me of how much can be lost over time if as professionalpractitioners we do> not have the vision and assertiveness to fight and make the case for whatwe understand to be> good practice. I write as someone with regrets that I have not been asvocal as I now> understand I needed to have been.>> Recent attention to "modernising" the role of the health visitor similarlygrieves me. In 1970> I began to work as a young and inexperienced health visitor. I wasemployed by the local> authority, and my nearest and only manager (the Superintendent HealthVisitor!) was 40 miles> away from my clinic base. From the point of view of protecting the publicI had a level of> freedom from supervision and monitoring which would rightly beunacceptable today. However,> that freedom also allowed me the flexibility and autonomy to attemptpractice as I had been> taught.>> What follows is an attempt to describe some of the values, priorities, andpractice of a young> and not very remarkable HV some 30+ years ago.>> 33 years ago my colleague and I developed antenatal classes incollaboration with the local> community midwife, a client who was a qualified physiotherapist, aMarriage Guidance (as it> then was) counsellor who wanted to do positive preventive work, and a GPwith a particular> commitment to obstetrics. Our classes were informal, used a variety ofteaching strategies,> and were increasingly client led. We involved fathers and indeed any"significant others"> including grandmothers on occasion. The gains postnatally were evident inhow many of those> who came to the classes approached the trials and tribulations of becomingparents, in the> informal support groups which developed out of the classes, in thecollaboration between> different professionals, and not least in the continuity of care whichclients felt they> experienced. We hadn't heard of partnership, interprofessionalcollaboration, client-centred> practice, healthy alliances, flexible ways of working, - but we understoodthat all those> things were an intrinsic part of what health visiting was all about.>> We also held early evening drop-in group sessions in early pregnancy forworking mothers-to-be> who could stop off for a drink and an informal chat, and this strategyhugely increased our> uptake of the main series of classes.>> The attitude of our employer was essentially benevolently hands-off.Evening work was> compensated by time in lieu, which we found almost more useful than extracash.>> So far as the birth visit was concerned, it was not often the firstcontact, as we also> routinely paid at least one antenatal visit. We knew that those earliestcontacts were most> importantly about building the foundations of a meaningful and effectiveworking relationship> with each family, establishing our street cred. with clients, and thatfrom the start the> client's agenda was as important as our own. Antenatal contact and visitsgave me Having> qualified as a health visitor who then worked as a community midwifebefore practising as a> health visitor, I didn't experience great dilemmas about overlap invisiting. What was far> more important was firstly having a clear reason for visiting as a healthvisitor which didn't> duplicate what the midwife was doing and secondly investing in goodworking relationships with> the midwives so that neither professional group felt undermined by theother.>> I had a large caseload in a new town - mainly families dislocated fromtheir family networks> and areas of origin, who came to this area for work. I and my colleagueslacked adequate> preparation for identifying and dealing with child protection and domesticviolence. However,> from the outset we were committed to the notion of working for the longterm futures of our> clients and placed great importance on sufficient effort and input tobuild valued> relationships with clients early on in our contact with them. Sometimesthat was achieved by> sustained home visiting and sometimes through informal group work withsmall groups. Without> doubt this was not uncommonly to the detriment of routine contacts in thehome later on, but> at least many clients remembered us and contacted us in times of needbecause of their early> experiences of us. Then as now there was the problem of whether auniversal service was> anything more than a cheerful fantasy - but a single contact at a birthvisit would have been> seen as meaningless.>> I became aware of a local need amongst the "well" elderly (although I hadnever heard of needs> assessment!) - living alone, isolated, on low income. I was told they were"unclubbable" and> that efforts to set up a lunch club had foundered. I took advice from alocal WRVS worker,> recruited 12 "well" elderly as a team, and after 12 months was able tobegin a club on local> church premises which is still running today after more than 30 years andlong after I left> the area. I learned how to find pump priming funding, how to build theteam's confidence in> their ability, and the challenges of recruiting a leader/organiser. Wehired a bus from a> local voluntary group to bring people who were wheelchair bound, and Ifound a retired lorry> driver to be the regular driver/club handyman. would not onlytransport members, but do> fixing jobs in members' homes - on one occasion an elderly woman was intears because her bed> had collapsed, and by teatime had put it right. I made sure clubboundaries were> blurred. If someone crippled with osteoarthritis could peel a fewpotatoes, she could see> herself as a provider rather than a consumer. The woman who took the moneyat the door also> knew who was ill or needed help - and later, when she was terminally illwith cancer club> members came to her aid and support. I deliberately recruited couples aswell as the single> and isolated, and the former often brought life and stimulus into thegroup. Then when a> partner died the club was there for the one who was left. I hadn't heardof a "special" public> health approach to practice or of community development. Public health andcommunity> development were simply and intrinsically what health visiting was aboutand this was how they> were translated into everyday working.>> When an insanitary local rubbish tip near to the homes of young familiesneeded closing I> joined with local teachers, householders and other agencies to fightsuccessfully for the> closure. When the company constructing the large new town development leftnowhere for> children to play safely I joined other agencies in lobbying, againsuccessfully, for some> redrafting of the plans.>> The point I am trying to make is that I was not unusual, and that thosewith whom I worked all> understood that these activities were as much a part of what healthvisiting was about as the> other activities which Senate contributors have recently been describingas "traditional". It> wasn't "better in the good old days" - although the context was differentthere was as much> scope for very poor practice as there is today, and there were many of thesame problems as> today which are still unresolved. Health visitors were a diverse bunch ofindividuals, but> there was one thing which was very different then from now.Health visitorshad a strong sense> of what it was to be a health visitor which united them solidly. Theymight not have been any> better then than now at articulating exactly what a health visitor is, butwhen in 1972 the> Briggs Report proposed the title of "family health sister" and began theprocess by which> health visiting was ultimately drawn under the statutory control ofnursing, health visitors> UK wide were vociferous and pretty united in opposition. My sadness todayincludes the> awareness that as a group health visitors are more fragmented anduncertain as to how they> regard themselves, and more willing to accept without question the rightof civil servants,> MPs, and non-health visiting managers to tell them what they are.>> Health visiting began as a public health activity, has its roots in theneed to reconcile> social, political, environmental, and individual factors which affect thequality of people's> lives and health, and hasn't essentially changed in this respect. Itbegins with the> individual and the messiness of individual differences and diversity.Therefore without home> visiting it cannot be effective. But it sees the individual's needs asonly being fully> understood in the context of the family, the local population, thecommunity and the wider> society. If what we are doing has departed too far from this, it might beworthwhile, but it> isn't health visiting.>> Betty >>>>

[Guest guest]

I am sorry but I will be out of the office from Friday 11 April 2003 until

Wednesday 23 April

2003.

[Guest guest]

I think and am increasingly aware that all professions and not only those in health struggle like this.

In terms of health nurses are better or worse you might say at moaning and getting it out in the open. someone said to me yesterday - I went to visit a group of GPS last week and they are in a worst state then we are.

why are we defensive - often because we are threatened and profession protective but also because as Ann says the lack of support and lack of understanding.

As HVs I think we are so used to being challenged and examining our navels that we almost do it automatically without being asked as a defence mechanism. Remember I have been around in health visiting for more years than most and I guess in many ways I am quite cynical!!

Margaret

I thought people might be interested in this.

Parents warned about “unhelpful teaching”

Parents who teach their pre-school children to read, write and add could be setting them up for mental health problems later in life, the Royal College of Paediatrics and Child Health says. A report issued today (04/04/03) encourages patients to interact with their infants through informal play, but warns against adopting a formal teaching approach. The study investigates why so many children have emotional and behavioural problems at a time when they are healthier and better educated than ever. It blames “unhelpful parenting practices” and a lack of understanding among parents of child development.(The Times 04/04/03; p.19)© HMG Worldwide 2003http://www.health-news.co.uk/

Babies of divorced parents suffer

”Babies forced to spend nights in the separate homes of divorced or separated parents often suffer emotional and physical anguish, according to new research. Such infants have more tantrums, develop eating and sleeping disorders, and exhibit distress through symptoms such as raised heartbeats. They also fail to identify their mothers as a source of comfort because they are confused by her regular absences. The findings were made in the world’s first study of how infants’ attachment to their parents is affected by overnight stays.(The Daily Telegraph 04/04/03; p.13)© HMG Worldwide 2003http://www.health-news.co.uk/

[Guest guest]

Penny

I agree about the need for us to " research " i.e. look more deeply and

carefully at what we are doing and work out the value of it.

The approach to health visiting Betty outlines would meet many of the

clinical governance objectives set out for us in 2003 practice such as-

- developing meaningful relationships with NHS service users.

- promoting the value of life long learning and a culture of learning in GP

/Primary Hesalth Care Practice

- encouraging volunteering in Primary Health Care

- developing the social capital of each neighbourhood so that people support

and help each other when the need arises.

and much more.

all this could and should be researched.

Malcolm

Re: I thought people might be interested in this.

>

>

> I have been following this correspondence with a great degree of sadness

as it provides yet

> another example to me of how much can be lost over time if as professional

practitioners we do

> not have the vision and assertiveness to fight and make the case for what

we understand to be

> good practice. I write as someone with regrets that I have not been as

vocal as I now

> understand I needed to have been.

>

> Recent attention to " modernising " the role of the health visitor similarly

grieves me. In 1970

> I began to work as a young and inexperienced health visitor. I was

employed by the local

> authority, and my nearest and only manager (the Superintendent Health

Visitor!) was 40 miles

> away from my clinic base. From the point of view of protecting the public

I had a level of

> freedom from supervision and monitoring which would rightly be

unacceptable today. However,

> that freedom also allowed me the flexibility and autonomy to attempt

practice as I had been

> taught.

>

> What follows is an attempt to describe some of the values, priorities, and

practice of a young

> and not very remarkable HV some 30+ years ago.

>

> 33 years ago my colleague and I developed antenatal classes in

collaboration with the local

> community midwife, a client who was a qualified physiotherapist, a

Marriage Guidance (as it

> then was) counsellor who wanted to do positive preventive work, and a GP

with a particular

> commitment to obstetrics. Our classes were informal, used a variety of

teaching strategies,

> and were increasingly client led. We involved fathers and indeed any

" significant others "

> including grandmothers on occasion. The gains postnatally were evident in

how many of those

> who came to the classes approached the trials and tribulations of becoming

parents, in the

> informal support groups which developed out of the classes, in the

collaboration between

> different professionals, and not least in the continuity of care which

clients felt they

> experienced. We hadn't heard of partnership, interprofessional

collaboration, client-centred

> practice, healthy alliances, flexible ways of working, - but we understood

that all those

> things were an intrinsic part of what health visiting was all about.

>

> We also held early evening drop-in group sessions in early pregnancy for

working mothers-to-be

> who could stop off for a drink and an informal chat, and this strategy

hugely increased our

> uptake of the main series of classes.

>

> The attitude of our employer was essentially benevolently hands-off.

Evening work was

> compensated by time in lieu, which we found almost more useful than extra

cash.

>

> So far as the birth visit was concerned, it was not often the first

contact, as we also

> routinely paid at least one antenatal visit. We knew that those earliest

contacts were most

> importantly about building the foundations of a meaningful and effective

working relationship

> with each family, establishing our street cred. with clients, and that

from the start the

> client's agenda was as important as our own. Antenatal contact and visits

gave me Having

> qualified as a health visitor who then worked as a community midwife

before practising as a

> health visitor, I didn't experience great dilemmas about overlap in

visiting. What was far

> more important was firstly having a clear reason for visiting as a health

visitor which didn't

> duplicate what the midwife was doing and secondly investing in good

working relationships with

> the midwives so that neither professional group felt undermined by the

other.

>

> I had a large caseload in a new town - mainly families dislocated from

their family networks

> and areas of origin, who came to this area for work. I and my colleagues

lacked adequate

> preparation for identifying and dealing with child protection and domestic

violence. However,

> from the outset we were committed to the notion of working for the long

term futures of our

> clients and placed great importance on sufficient effort and input to

build valued

> relationships with clients early on in our contact with them. Sometimes

that was achieved by

> sustained home visiting and sometimes through informal group work with

small groups. Without

> doubt this was not uncommonly to the detriment of routine contacts in the

home later on, but

> at least many clients remembered us and contacted us in times of need

because of their early

> experiences of us. Then as now there was the problem of whether a

universal service was

> anything more than a cheerful fantasy - but a single contact at a birth

visit would have been

> seen as meaningless.

>

> I became aware of a local need amongst the " well " elderly (although I had

never heard of needs

> assessment!) - living alone, isolated, on low income. I was told they were

" unclubbable " and

> that efforts to set up a lunch club had foundered. I took advice from a

local WRVS worker,

> recruited 12 " well " elderly as a team, and after 12 months was able to

begin a club on local

> church premises which is still running today after more than 30 years and

long after I left

> the area. I learned how to find pump priming funding, how to build the

team's confidence in

> their ability, and the challenges of recruiting a leader/organiser. We

hired a bus from a

> local voluntary group to bring people who were wheelchair bound, and I

found a retired lorry

> driver to be the regular driver/club handyman. would not only

transport members, but do

> fixing jobs in members' homes - on one occasion an elderly woman was in

tears because her bed

> had collapsed, and by teatime had put it right. I made sure club

boundaries were

> blurred. If someone crippled with osteoarthritis could peel a few

potatoes, she could see

> herself as a provider rather than a consumer. The woman who took the money

at the door also

> knew who was ill or needed help - and later, when she was terminally ill

with cancer club

> members came to her aid and support. I deliberately recruited couples as

well as the single

> and isolated, and the former often brought life and stimulus into the

group. Then when a

> partner died the club was there for the one who was left. I hadn't heard

of a " special " public

> health approach to practice or of community development. Public health and

community

> development were simply and intrinsically what health visiting was about

and this was how they

> were translated into everyday working.

>

> When an insanitary local rubbish tip near to the homes of young families

needed closing I

> joined with local teachers, householders and other agencies to fight

successfully for the

> closure. When the company constructing the large new town development left

nowhere for

> children to play safely I joined other agencies in lobbying, again

successfully, for some

> redrafting of the plans.

>

> The point I am trying to make is that I was not unusual, and that those

with whom I worked all

> understood that these activities were as much a part of what health

visiting was about as the

> other activities which Senate contributors have recently been describing

as " traditional " . It

> wasn't " better in the good old days " - although the context was different

there was as much

> scope for very poor practice as there is today, and there were many of the

same problems as

> today which are still unresolved. Health visitors were a diverse bunch of

individuals, but

> there was one thing which was very different then from now.Health visitors

had a strong sense

> of what it was to be a health visitor which united them solidly. They

might not have been any

> better then than now at articulating exactly what a health visitor is, but

when in 1972 the

> Briggs Report proposed the title of " family health sister " and began the

process by which

> health visiting was ultimately drawn under the statutory control of

nursing, health visitors

> UK wide were vociferous and pretty united in opposition. My sadness today

includes the

> awareness that as a group health visitors are more fragmented and

uncertain as to how they

> regard themselves, and more willing to accept without question the right

of civil servants,

> MPs, and non-health visiting managers to tell them what they are.

>

> Health visiting began as a public health activity, has its roots in the

need to reconcile

> social, political, environmental, and individual factors which affect the

quality of people's

> lives and health, and hasn't essentially changed in this respect. It

begins with the

> individual and the messiness of individual differences and diversity.

Therefore without home

> visiting it cannot be effective. But it sees the individual's needs as

only being fully

> understood in the context of the family, the local population, the

community and the wider

> society. If what we are doing has departed too far from this, it might be

worthwhile, but it

> isn't health visiting.

>

> Betty

>

>

>

>

[Guest guest]

Hi Betty

I just want to say thank you - it feels so right what you have written and

is my memory of practice - it feels like a different world but it isn't

really - it was one as you say where health visitors knew what " to health

visit was " and one where they felt able to do so.

Margaret

Re: I thought people might be interested in this.

> I have been following this correspondence with a great degree of sadness

as it provides yet

> another example to me of how much can be lost over time if as professional

practitioners we do

> not have the vision and assertiveness to fight and make the case for what

we understand to be

> good practice. I write as someone with regrets that I have not been as

vocal as I now

> understand I needed to have been.

>

> Recent attention to " modernising " the role of the health visitor similarly

grieves me. In 1970

> I began to work as a young and inexperienced health visitor. I was

employed by the local

> authority, and my nearest and only manager (the Superintendent Health

Visitor!) was 40 miles

> away from my clinic base. From the point of view of protecting the public

I had a level of

> freedom from supervision and monitoring which would rightly be

unacceptable today. However,

> that freedom also allowed me the flexibility and autonomy to attempt

practice as I had been

> taught.

>

> What follows is an attempt to describe some of the values, priorities, and

practice of a young

> and not very remarkable HV some 30+ years ago.

>

> 33 years ago my colleague and I developed antenatal classes in

collaboration with the local

> community midwife, a client who was a qualified physiotherapist, a

Marriage Guidance (as it

> then was) counsellor who wanted to do positive preventive work, and a GP

with a particular

> commitment to obstetrics. Our classes were informal, used a variety of

teaching strategies,

> and were increasingly client led. We involved fathers and indeed any

" significant others "

> including grandmothers on occasion. The gains postnatally were evident in

how many of those

> who came to the classes approached the trials and tribulations of becoming

parents, in the

> informal support groups which developed out of the classes, in the

collaboration between

> different professionals, and not least in the continuity of care which

clients felt they

> experienced. We hadn't heard of partnership, interprofessional

collaboration, client-centred

> practice, healthy alliances, flexible ways of working, - but we understood

that all those

> things were an intrinsic part of what health visiting was all about.

>

> We also held early evening drop-in group sessions in early pregnancy for

working mothers-to-be

> who could stop off for a drink and an informal chat, and this strategy

hugely increased our

> uptake of the main series of classes.

>

> The attitude of our employer was essentially benevolently hands-off.

Evening work was

> compensated by time in lieu, which we found almost more useful than extra

cash.

>

> So far as the birth visit was concerned, it was not often the first

contact, as we also

> routinely paid at least one antenatal visit. We knew that those earliest

contacts were most

> importantly about building the foundations of a meaningful and effective

working relationship

> with each family, establishing our street cred. with clients, and that

from the start the

> client's agenda was as important as our own. Antenatal contact and visits

gave me Having

> qualified as a health visitor who then worked as a community midwife

before practising as a

> health visitor, I didn't experience great dilemmas about overlap in

visiting. What was far

> more important was firstly having a clear reason for visiting as a health

visitor which didn't

> duplicate what the midwife was doing and secondly investing in good

working relationships with

> the midwives so that neither professional group felt undermined by the

other.

>

> I had a large caseload in a new town - mainly families dislocated from

their family networks

> and areas of origin, who came to this area for work. I and my colleagues

lacked adequate

> preparation for identifying and dealing with child protection and domestic

violence. However,

> from the outset we were committed to the notion of working for the long

term futures of our

> clients and placed great importance on sufficient effort and input to

build valued

> relationships with clients early on in our contact with them. Sometimes

that was achieved by

> sustained home visiting and sometimes through informal group work with

small groups. Without

> doubt this was not uncommonly to the detriment of routine contacts in the

home later on, but

> at least many clients remembered us and contacted us in times of need

because of their early

> experiences of us. Then as now there was the problem of whether a

universal service was

> anything more than a cheerful fantasy - but a single contact at a birth

visit would have been

> seen as meaningless.

>

> I became aware of a local need amongst the " well " elderly (although I had

never heard of needs

> assessment!) - living alone, isolated, on low income. I was told they were

" unclubbable " and

> that efforts to set up a lunch club had foundered. I took advice from a

local WRVS worker,

> recruited 12 " well " elderly as a team, and after 12 months was able to

begin a club on local

> church premises which is still running today after more than 30 years and

long after I left

> the area. I learned how to find pump priming funding, how to build the

team's confidence in

> their ability, and the challenges of recruiting a leader/organiser. We

hired a bus from a

> local voluntary group to bring people who were wheelchair bound, and I

found a retired lorry

> driver to be the regular driver/club handyman. would not only

transport members, but do

> fixing jobs in members' homes - on one occasion an elderly woman was in

tears because her bed

> had collapsed, and by teatime had put it right. I made sure club

boundaries were

> blurred. If someone crippled with osteoarthritis could peel a few

potatoes, she could see

> herself as a provider rather than a consumer. The woman who took the money

at the door also

> knew who was ill or needed help - and later, when she was terminally ill

with cancer club

> members came to her aid and support. I deliberately recruited couples as

well as the single

> and isolated, and the former often brought life and stimulus into the

group. Then when a

> partner died the club was there for the one who was left. I hadn't heard

of a " special " public

> health approach to practice or of community development. Public health and

community

> development were simply and intrinsically what health visiting was about

and this was how they

> were translated into everyday working.

>

> When an insanitary local rubbish tip near to the homes of young families

needed closing I

> joined with local teachers, householders and other agencies to fight

successfully for the

> closure. When the company constructing the large new town development left

nowhere for

> children to play safely I joined other agencies in lobbying, again

successfully, for some

> redrafting of the plans.

>

> The point I am trying to make is that I was not unusual, and that those

with whom I worked all

> understood that these activities were as much a part of what health

visiting was about as the

> other activities which Senate contributors have recently been describing

as " traditional " . It

> wasn't " better in the good old days " - although the context was different

there was as much

> scope for very poor practice as there is today, and there were many of the

same problems as

> today which are still unresolved. Health visitors were a diverse bunch of

individuals, but

> there was one thing which was very different then from now.Health visitors

had a strong sense

> of what it was to be a health visitor which united them solidly. They

might not have been any

> better then than now at articulating exactly what a health visitor is, but

when in 1972 the

> Briggs Report proposed the title of " family health sister " and began the

process by which

> health visiting was ultimately drawn under the statutory control of

nursing, health visitors

> UK wide were vociferous and pretty united in opposition. My sadness today

includes the

> awareness that as a group health visitors are more fragmented and

uncertain as to how they

> regard themselves, and more willing to accept without question the right

of civil servants,

> MPs, and non-health visiting managers to tell them what they are.

>

> Health visiting began as a public health activity, has its roots in the

need to reconcile

> social, political, environmental, and individual factors which affect the

quality of people's

> lives and health, and hasn't essentially changed in this respect. It

begins with the

> individual and the messiness of individual differences and diversity.

Therefore without home

> visiting it cannot be effective. But it sees the individual's needs as

only being fully

> understood in the context of the family, the local population, the

community and the wider

> society. If what we are doing has departed too far from this, it might be

worthwhile, but it

> isn't health visiting.

>

> Betty

>

>

>

>

[Guest guest]

I am sorry but I will be out of the office from Friday 11 April 2003 until

Wednesday 23 April

2003.

[Guest guest]

I am sorry but I will be out of the office from Friday 11 April 2003 until

Wednesday 23 April

2003.

[Guest guest]

I am sorry but I will be out of the office from Friday 11 April 2003 until

Wednesday 23 April

2003.

[Guest guest]

I agree with Margaret. But I'm still puzzled to find this sort of

discussion going on. What does this stuff about 'overlap' between

MW and HV amount to? They're different professions with a

different focus, different care objectives.

As for timing, 28 days post delivery is a bit late to be offering a family

based public health role. If the mother is sick and needs her

midwife's care or the baby has special problems which need a

specific midwifery input, surely the MW should visit until the need is

addressed or refer for specialist help if it's beyond the scope of her

skills. The midwife isn't there to do health visiting work for the family.

Betty's picture of generic health visiting is the one I have worked with

and understand best.

HVs should be able to meet local expectant parents as a matter of

course and acquaint them with the HV service and what it offers

them, start to make a relationship, undertake some parenting

education in a way which meets family needs. Contact doesn't have

to wait until there's an infant in the cot - that would only be relevant if

HVs provided a simple medical screening process rather than their

own services.

.

On 12 Apr 2003 at 6:17, Margaret Buttigieg wrote:

> Hi Betty

>

> I just want to say thank you - it feels so right what you have written and

> is my memory of practice - it feels like a different world but it isn't

> really - it was one as you say where health visitors knew what " to health

> visit was " and one where they felt able to do so.

>

> Margaret

> Re: I thought people might be interested in this.

>

>

> > I have been following this correspondence with a great degree of sadness

> as it provides yet

> > another example to me of how much can be lost over time if as professional

> practitioners we do

> > not have the vision and assertiveness to fight and make the case for what

> we understand to be

> > good practice. I write as someone with regrets that I have not been as

> vocal as I now

> > understand I needed to have been.

> >

> > Recent attention to " modernising " the role of the health visitor similarly

> grieves me. In 1970

> > I began to work as a young and inexperienced health visitor. I was

> employed by the local

> > authority, and my nearest and only manager (the Superintendent Health

> Visitor!) was 40 miles

> > away from my clinic base. From the point of view of protecting the public

> I had a level of

> > freedom from supervision and monitoring which would rightly be

> unacceptable today. However,

> > that freedom also allowed me the flexibility and autonomy to attempt

> practice as I had been

> > taught.

> >

> > What follows is an attempt to describe some of the values, priorities, and

> practice of a young

> > and not very remarkable HV some 30+ years ago.

> >

> > 33 years ago my colleague and I developed antenatal classes in

> collaboration with the local

> > community midwife, a client who was a qualified physiotherapist, a

> Marriage Guidance (as it

> > then was) counsellor who wanted to do positive preventive work, and a GP

> with a particular

> > commitment to obstetrics. Our classes were informal, used a variety of

> teaching strategies,

> > and were increasingly client led. We involved fathers and indeed any

> " significant others "

> > including grandmothers on occasion. The gains postnatally were evident in

> how many of those

> > who came to the classes approached the trials and tribulations of becoming

> parents, in the

> > informal support groups which developed out of the classes, in the

> collaboration between

> > different professionals, and not least in the continuity of care which

> clients felt they

> > experienced. We hadn't heard of partnership, interprofessional

> collaboration, client-centred

> > practice, healthy alliances, flexible ways of working, - but we understood

> that all those

> > things were an intrinsic part of what health visiting was all about.

> >

> > We also held early evening drop-in group sessions in early pregnancy for

> working mothers-to-be

> > who could stop off for a drink and an informal chat, and this strategy

> hugely increased our

> > uptake of the main series of classes.

> >

> > The attitude of our employer was essentially benevolently hands-off.

> Evening work was

> > compensated by time in lieu, which we found almost more useful than extra

> cash.

> >

> > So far as the birth visit was concerned, it was not often the first

> contact, as we also

> > routinely paid at least one antenatal visit. We knew that those earliest

> contacts were most

> > importantly about building the foundations of a meaningful and effective

> working relationship

> > with each family, establishing our street cred. with clients, and that

> from the start the

> > client's agenda was as important as our own. Antenatal contact and visits

> gave me Having

> > qualified as a health visitor who then worked as a community midwife

> before practising as a

> > health visitor, I didn't experience great dilemmas about overlap in

> visiting. What was far

> > more important was firstly having a clear reason for visiting as a health

> visitor which didn't

> > duplicate what the midwife was doing and secondly investing in good

> working relationships with

> > the midwives so that neither professional group felt undermined by the

> other.

> >

> > I had a large caseload in a new town - mainly families dislocated from

> their family networks

> > and areas of origin, who came to this area for work. I and my colleagues

> lacked adequate

> > preparation for identifying and dealing with child protection and domestic

> violence. However,

> > from the outset we were committed to the notion of working for the long

> term futures of our

> > clients and placed great importance on sufficient effort and input to

> build valued

> > relationships with clients early on in our contact with them. Sometimes

> that was achieved by

> > sustained home visiting and sometimes through informal group work with

> small groups. Without

> > doubt this was not uncommonly to the detriment of routine contacts in the

> home later on, but

> > at least many clients remembered us and contacted us in times of need

> because of their early

> > experiences of us. Then as now there was the problem of whether a

> universal service was

> > anything more than a cheerful fantasy - but a single contact at a birth

> visit would have been

> > seen as meaningless.

> >

> > I became aware of a local need amongst the " well " elderly (although I had

> never heard of needs

> > assessment!) - living alone, isolated, on low income. I was told they were

> " unclubbable " and

> > that efforts to set up a lunch club had foundered. I took advice from a

> local WRVS worker,

> > recruited 12 " well " elderly as a team, and after 12 months was able to

> begin a club on local

> > church premises which is still running today after more than 30 years and

> long after I left

> > the area. I learned how to find pump priming funding, how to build the

> team's confidence in

> > their ability, and the challenges of recruiting a leader/organiser. We

> hired a bus from a

> > local voluntary group to bring people who were wheelchair bound, and I

> found a retired lorry

> > driver to be the regular driver/club handyman. would not only

> transport members, but do

> > fixing jobs in members' homes - on one occasion an elderly woman was in

> tears because her bed

> > had collapsed, and by teatime had put it right. I made sure club

> boundaries were

> > blurred. If someone crippled with osteoarthritis could peel a few

> potatoes, she could see

> > herself as a provider rather than a consumer. The woman who took the money

> at the door also

> > knew who was ill or needed help - and later, when she was terminally ill

> with cancer club

> > members came to her aid and support. I deliberately recruited couples as

> well as the single

> > and isolated, and the former often brought life and stimulus into the

> group. Then when a

> > partner died the club was there for the one who was left. I hadn't heard

> of a " special " public

> > health approach to practice or of community development. Public health and

> community

> > development were simply and intrinsically what health visiting was about

> and this was how they

> > were translated into everyday working.

> >

> > When an insanitary local rubbish tip near to the homes of young families

> needed closing I

> > joined with local teachers, householders and other agencies to fight

> successfully for the

> > closure. When the company constructing the large new town development left

> nowhere for

> > children to play safely I joined other agencies in lobbying, again

> successfully, for some

> > redrafting of the plans.

> >

> > The point I am trying to make is that I was not unusual, and that those

> with whom I worked all

> > understood that these activities were as much a part of what health

> visiting was about as the

> > other activities which Senate contributors have recently been describing

> as " traditional " . It

> > wasn't " better in the good old days " - although the context was different

> there was as much

> > scope for very poor practice as there is today, and there were many of the

> same problems as

> > today which are still unresolved. Health visitors were a diverse bunch of

> individuals, but

> > there was one thing which was very different then from now.Health visitors

> had a strong sense

> > of what it was to be a health visitor which united them solidly. They

> might not have been any

> > better then than now at articulating exactly what a health visitor is, but

> when in 1972 the

> > Briggs Report proposed the title of " family health sister " and began the

> process by which

> > health visiting was ultimately drawn under the statutory control of

> nursing, health visitors

> > UK wide were vociferous and pretty united in opposition. My sadness today

> includes the

> > awareness that as a group health visitors are more fragmented and

> uncertain as to how they

> > regard themselves, and more willing to accept without question the right

> of civil servants,

> > MPs, and non-health visiting managers to tell them what they are.

> >

> > Health visiting began as a public health activity, has its roots in the

> need to reconcile

> > social, political, environmental, and individual factors which affect the

> quality of people's

> > lives and health, and hasn't essentially changed in this respect. It

> begins with the

> > individual and the messiness of individual differences and diversity.

> Therefore without home

> > visiting it cannot be effective. But it sees the individual's needs as

> only being fully

> > understood in the context of the family, the local population, the

> community and the wider

> > society. If what we are doing has departed too far from this, it might be

> worthwhile, but it

> > isn't health visiting.

> >

> > Betty

> >

> >

> >

> >

[Guest guest]

I am sorry but I will be out of the office from Friday 11 April 2003 until

Wednesday 23 April

2003.

[Guest guest]

Yes I do agree and of course the times we are reflecting on we did not have the drugs and were not able to use medicine and technology the way we do today.

It isn't that long ago but we have come a really long way in many areas which has to bring change

Margaret

Re: I thought people might be interested in this.> I have been following this correspondence with a great degree of sadnessas it provides yet> another example to me of how much can be lost over time if as professionalpractitioners we do> not have the vision and assertiveness to fight and make the case for whatwe understand to be> good practice. I write as someone with regrets that I have not been asvocal as I now> understand I needed to have been.>> Recent attention to "modernising" the role of the health visitor similarlygrieves me. In 1970> I began to work as a young and inexperienced health visitor. I wasemployed by the local> authority, and my nearest and only manager (the Superintendent HealthVisitor!) was 40 miles> away from my clinic base. From the point of view of protecting the publicI had a level of> freedom from supervision and monitoring which would rightly beunacceptable today. However,> that freedom also allowed me the flexibility and autonomy to attemptpractice as I had been> taught.>> What follows is an attempt to describe some of the values, priorities, andpractice of a young> and not very remarkable HV some 30+ years ago.>> 33 years ago my colleague and I developed antenatal classes incollaboration with the local> community midwife, a client who was a qualified physiotherapist, aMarriage Guidance (as it> then was) counsellor who wanted to do positive preventive work, and a GPwith a particular> commitment to obstetrics. Our classes were informal, used a variety ofteaching strategies,> and were increasingly client led. We involved fathers and indeed any"significant others"> including grandmothers on occasion. The gains postnatally were evident inhow many of those> who came to the classes approached the trials and tribulations of becomingparents, in the> informal support groups which developed out of the classes, in thecollaboration between> different professionals, and not least in the continuity of care whichclients felt they> experienced. We hadn't heard of partnership, interprofessionalcollaboration, client-centred> practice, healthy alliances, flexible ways of working, - but we understoodthat all those> things were an intrinsic part of what health visiting was all about.>> We also held early evening drop-in group sessions in early pregnancy forworking mothers-to-be> who could stop off for a drink and an informal chat, and this strategyhugely increased our> uptake of the main series of classes.>> The attitude of our employer was essentially benevolently hands-off.Evening work was> compensated by time in lieu, which we found almost more useful than extracash.>> So far as the birth visit was concerned, it was not often the firstcontact, as we also> routinely paid at least one antenatal visit. We knew that those earliestcontacts were most> importantly about building the foundations of a meaningful and effectiveworking relationship> with each family, establishing our street cred. with clients, and thatfrom the start the> client's agenda was as important as our own. Antenatal contact and visitsgave me Having> qualified as a health visitor who then worked as a community midwifebefore practising as a> health visitor, I didn't experience great dilemmas about overlap invisiting. What was far> more important was firstly having a clear reason for visiting as a healthvisitor which didn't> duplicate what the midwife was doing and secondly investing in goodworking relationships with> the midwives so that neither professional group felt undermined by theother.>> I had a large caseload in a new town - mainly families dislocated fromtheir family networks> and areas of origin, who came to this area for work. I and my colleagueslacked adequate> preparation for identifying and dealing with child protection and domesticviolence. However,> from the outset we were committed to the notion of working for the longterm futures of our> clients and placed great importance on sufficient effort and input tobuild valued> relationships with clients early on in our contact with them. Sometimesthat was achieved by> sustained home visiting and sometimes through informal group work withsmall groups. Without> doubt this was not uncommonly to the detriment of routine contacts in thehome later on, but> at least many clients remembered us and contacted us in times of needbecause of their early> experiences of us. Then as now there was the problem of whether auniversal service was> anything more than a cheerful fantasy - but a single contact at a birthvisit would have been> seen as meaningless.>> I became aware of a local need amongst the "well" elderly (although I hadnever heard of needs> assessment!) - living alone, isolated, on low income. I was told they were"unclubbable" and> that efforts to set up a lunch club had foundered. I took advice from alocal WRVS worker,> recruited 12 "well" elderly as a team, and after 12 months was able tobegin a club on local> church premises which is still running today after more than 30 years andlong after I left> the area. I learned how to find pump priming funding, how to build theteam's confidence in> their ability, and the challenges of recruiting a leader/organiser. Wehired a bus from a> local voluntary group to bring people who were wheelchair bound, and Ifound a retired lorry> driver to be the regular driver/club handyman. would not onlytransport members, but do> fixing jobs in members' homes - on one occasion an elderly woman was intears because her bed> had collapsed, and by teatime had put it right. I made sure clubboundaries were> blurred. If someone crippled with osteoarthritis could peel a fewpotatoes, she could see> herself as a provider rather than a consumer. The woman who took the moneyat the door also> knew who was ill or needed help - and later, when she was terminally illwith cancer club> members came to her aid and support. I deliberately recruited couples aswell as the single> and isolated, and the former often brought life and stimulus into thegroup. Then when a> partner died the club was there for the one who was left. I hadn't heardof a "special" public> health approach to practice or of community development. Public health andcommunity> development were simply and intrinsically what health visiting was aboutand this was how they> were translated into everyday working.>> When an insanitary local rubbish tip near to the homes of young familiesneeded closing I> joined with local teachers, householders and other agencies to fightsuccessfully for the> closure. When the company constructing the large new town development leftnowhere for> children to play safely I joined other agencies in lobbying, againsuccessfully, for some> redrafting of the plans.>> The point I am trying to make is that I was not unusual, and that thosewith whom I worked all> understood that these activities were as much a part of what healthvisiting was about as the> other activities which Senate contributors have recently been describingas "traditional". It> wasn't "better in the good old days" - although the context was differentthere was as much> scope for very poor practice as there is today, and there were many of thesame problems as> today which are still unresolved. Health visitors were a diverse bunch ofindividuals, but> there was one thing which was very different then from now.Health visitorshad a strong sense> of what it was to be a health visitor which united them solidly. Theymight not have been any> better then than now at articulating exactly what a health visitor is, butwhen in 1972 the> Briggs Report proposed the title of "family health sister" and began theprocess by which> health visiting was ultimately drawn under the statutory control ofnursing, health visitors> UK wide were vociferous and pretty united in opposition. My sadness todayincludes the> awareness that as a group health visitors are more fragmented anduncertain as to how they> regard themselves, and more willing to accept without question the rightof civil servants,> MPs, and non-health visiting managers to tell them what they are.>> Health visiting began as a public health activity, has its roots in theneed to reconcile> social, political, environmental, and individual factors which affect thequality of people's> lives and health, and hasn't essentially changed in this respect. Itbegins with the> individual and the messiness of individual differences and diversity.Therefore without home> visiting it cannot be effective. But it sees the individual's needs asonly being fully> understood in the context of the family, the local population, thecommunity and the wider> society. If what we are doing has departed too far from this, it might beworthwhile, but it> isn't health visiting.>> Betty >>>>

[Guest guest]

I am sorry but I will be out of the office from Friday 11 April 2003 until

Wednesday 23 April

2003.