Re: Children's National Service Framework

[Guest guest]

Dear

I had a brief look at some of it yesterday.

In the light of what is happening in Cambridge and elsewhere - i.e. non-health visitors doing the New Birth Visit - am I correct in interpreting the document as saying that visit MUST be a HV or midwife (under Overview of the Child Health Promotion Programme pg27 at the top and pg36 section 3.18 Assessing Needs and Intervening Early), or am I clutching at straws?

Sheelah

-----Original Message-----From: Cowley [mailto:sarah@...]Sent: Wed, 22 Sep 2004 09:24 Subject: Children's National Service FrameworkJust back from an excellent conference in Western Australia and trying to catch up a bit. I see the Children's NSF has been published; another mega-document, hard to download and hard to find on the DH website ( http://www.dh.gov.uk/Home/fs/en). The key seems to be put the whole title nto their web search document, which is: "National Service Framework for Children, Young People and Maternity Services: Core Standards" There are multiple variations on the theme: executive summary, documents for parents, children etc; very hard to find the one for professionals! kind regardssarah

[Guest guest]

sheelah

please tell me this is not true! non-HV's doing new birth visits and needs assessment. Its only a matter of time really, when we all convince ourselves that quality doesn't matter, its only the health service, and i take it clinical governance agraid there were not risks involved? clients, practitioner or corporate.

i'd be interested in knowing more if you don't mind.

ta

mgt holtzSheelah Seeley <sheelah@...> wrote:

Dear

I had a brief look at some of it yesterday.

In the light of what is happening in Cambridge and elsewhere - i.e. non-health visitors doing the New Birth Visit - am I correct in interpreting the document as saying that visit MUST be a HV or midwife (under Overview of the Child Health Promotion Programme pg27 at the top and pg36 section 3.18 Assessing Needs and Intervening Early), or am I clutching at straws?

Sheelah

-----Original Message-----From: Cowley [mailto:sarah@...]Sent: Wed, 22 Sep 2004 09:24 Subject: Children's National Service FrameworkJust back from an excellent conference in Western Australia and trying to catch up a bit. I see the Children's NSF has been published; another mega-document, hard to download and hard to find on the DH website ( http://www.dh.gov.uk/Home/fs/en). The key seems to be put the whole title nto their web search document, which is: "National Service Framework for Children, Young People and Maternity Services: Core

Standards" There are multiple variations on the theme: executive summary, documents for parents, children etc; very hard to find the one for professionals! kind regardssarah

ALL-NEW Messenger - all new features - even more fun!

[Guest guest]

Yes Thank you for bringing this to our attention and when you are meant to holidaying! I think from looking at the website and experiencing the same confusion, that there are two for professionals, the Primary Care one and the Core Standards doc.

Anyhow from my quick scan of it I am very pleased that after the disappointing lack of parenting in the emerging findings, we now have a whole core standard dedicated (Number 2.) to Supporting Parents and Carers. Brilliant - this really does feel like a step in the right direction.

-----Original Message-----From: Cowley [mailto:sarah@...]Sent: 22 September 2004 09:24 Subject: Children's National Service FrameworkJust back from an excellent conference in Western Australia and trying to catch up a bit. I see the Children's NSF has been published; another mega-document, hard to download and hard to find on the DH website ( http://www.dh.gov.uk/Home/fs/en). The key seems to be put the whole title nto their web search document, which is: "National Service Framework for Children, Young People and Maternity Services: Core Standards" There are multiple variations on the theme: executive summary, documents for parents, children etc; very hard to find the one for professionals! kind regardssarah

[Guest guest]

Hello Sheelagh, Margaret and all,

I have not been able to download the whole 'core standards document' yet,

so will look at these pages with interest. Of course non-HVs do all sorts

of things now, because of staff shortages and because HV is no longer either

a statutory or a mandatory qualification, so it isn't necessary to hold it

for anything. Doesn't make it right, and as far as I know, only the old

Lifespan Trust in Cambridge made it into a virtue to replace health visitors,

but it is the natural consequence of our changed legal status. Some might

even say it was what all the battles were about, when the focus was on the

'name' of our profession.

The NSF document for primary care seems mainly positive, but a bit contradictory.

On the one hand, it is refreshingly clear in saying 'health visitor' when

that is what it means: not like the CNO review document which couldn't make

up its mind whether to talk of HV, PHN, SCPHN, RSCPHN-HV, PH specialist for

children or whatever! This document is completely clear that there is an

important role for the 'health visiting service' (ie, not always a qualified

health visitor) in providing a whole range of important support and health

promoting activities. It also says that every single practice (size was not

mentioned here: per single handed or ten-GP practice?) must have a named

health visitor. On the other hand, I did not find any activity that actually

had to be carried out by a health visitor. The expected core service is

set out in an Appendix. Either a health visitor or a midwife is able to

carry out the new birth assessment at 'around 12 days,' that seems to provide

a fair bit of leeway for anyone else to step in to introduce the service,

as long as midwives can officially covcr that assessment. It does look as

though the iniquitous 'one visit only' is to be the standard too, since the

new birth visit is the only one that is described as a 'visit.' All other

contacts can be through a variety of means, by a range of individuals and

they mainly consist of a minimum programme of screening and immunisations.

My first, fleeting impression is that there are some real opportunities here,

but that it will be no more helpful to us than the Hall 4 document was: lots

more talk about immunisations and GP training than other things, and quite

an absence of understanding about the kind of relationship-based work that

has been the focus of disucssion here on Senate over recent weeks. However,

there is also much emphasis on clinical governance, quality and evidence

based practice, and the overall thrust is very positive about children and

families and parent support.

I will keep trying to download the 'core standard' document, but will be

pleased to here of views from anyone else who has succeeded, about this or

any other parts of the NSF. kind regards

margaret holtz wrote:

sheelah

please tell me this is not true! non-HV's doing new birth visits and

needs assessment. Its only a matter of time really, when we all convince

ourselves that quality doesn't matter, its only the health service, and i

take it clinical governance agraid there were not risks involved? clients,

practitioner or corporate.

i'd be interested in knowing more if you don't mind.

ta

mgt holtz

Sheelah Seeley <sheelah@...> wrote:

Dear

I had a brief look at some of it yesterday.

In the light of what is happening in Cambridge and

elsewhere - i.e. non-health visitors doing the New Birth Visit - am I correct

in interpreting the document as saying that visit MUST be a HV or midwife

(under Overview of the Child Health Promotion Programme pg27 at the top and

pg36 section 3.18 Assessing Needs and Intervening Early), or am I clutching

at straws?

Sheelah

Children's National Service Framework

Just back from an excellent conference in Western Australia and trying to

catch up a bit. I see the Children's NSF has been published; another mega-document,

hard to download and hard to find on the DH website ( http://www.dh.gov.uk/Home/fs/en).

The key seems to be put the whole title nto their web search document, which

is:

"National

Service Framework for Children, Young People and Maternity Services: Core Standards" There

are multiple variations on the theme: executive summary, documents for parents,

children etc; very hard to find the one for professionals!

kind regards

sarah

ALL-NEW Messenger - all new features - even

more fun!

[Guest guest]

I agree . Is this the influence of ther DfES and 'Every Child Mattrers'

do you think? The document is jointly published by DH and DfES, although

I could not find any mention of it on the DfES website, and I see there is

no introductory message from Margaret Hodge, only from reid, even though

all the NSF civil servants are based in DfES. Interesting!

Whittaker wrote:

Yes Thank you for bringing this to our attention

and when you are meant to holidaying! I think from looking at the website

and experiencing the same confusion, that there are two for professionals,

the Primary Care one and the Core Standards doc.

Anyhow from my quick scan of it I am very pleased

that after the disappointing lack of parenting in the emerging findings, we

now have a whole core standard dedicated (Number 2.) to Supporting Parents

and Carers. Brilliant - this really does feel like a step in the right

direction.

Children's National Service Framework

Just back from an excellent conference in Western Australia and trying

to catch up a bit. I see the Children's NSF has been published; another

mega-document, hard to download and hard to find on the DH website ( http://www.dh.gov.uk/Home/fs/en).

The key seems to be put the whole title nto their web search document,

which is:

"National

Service Framework for Children, Young People and Maternity Services: Core

Standards" There

are multiple variations on the theme: executive summary, documents for

parents, children etc; very hard to find the one for professionals!

kind regards

sarah

[Guest guest]

Hi and anyone else who wants to read this,

It's rarely that i wish to defend Lifespan but health visitors were not replaced - they continue to exist and work their socks off!! However a lot went on that was not so good and individuals were treated very badly.

I also think health visitors have several things to consider in terms of new birth visits. Firstly as says there are not enough health visitors to go round so we do need to look at ways of delivering the service in a different way.

Also having searched the literature I have found none to support the new birth visit. Surely we need to consider assessments which may be done at any time and should be carried out by a qualifeid health visitor. Having assessed the needs of a family she can then delegate appropriately within the team to those they deem competent to perform the task.

Let's try and meet the needs of the families and stop being professionally so defensive. I have a colleague who has had a very difficult time because she has dared challenge custom and practice and frankly that has sickened me. She is a young dynamic health visitor and is likely to leave the profession because of these attitudes

I'm sure this will be considered sacrilege to some but after all Senate is about debating the issues.

Ann

Re: Children's National Service Framework

Hello Sheelagh, Margaret and all,I have not been able to download the whole 'core standards document' yet, so will look at these pages with interest. Of course non-HVs do all sorts of things now, because of staff shortages and because HV is no longer either a statutory or a mandatory qualification, so it isn't necessary to hold it for anything. Doesn't make it right, and as far as I know, only the old Lifespan Trust in Cambridge made it into a virtue to replace health visitors, but it is the natural consequence of our changed legal status. Some might even say it was what all the battles were about, when the focus was on the 'name' of our profession. The NSF document for primary care seems mainly positive, but a bit contradictory. On the one hand, it is refreshingly clear in saying 'health visitor' when that is what it means: not like the CNO review document which couldn't make up its mind whether to talk of HV, PHN, SCPHN, RSCPHN-HV, PH specialist for children or whatever! This document is completely clear that there is an important role for the 'health visiting service' (ie, not always a qualified health visitor) in providing a whole range of important support and health promoting activities. It also says that every single practice (size was not mentioned here: per single handed or ten-GP practice?) must have a named health visitor. On the other hand, I did not find any activity that actually had to be carried out by a health visitor. The expected core service is set out in an Appendix. Either a health visitor or a midwife is able to carry out the new birth assessment at 'around 12 days,' that seems to provide a fair bit of leeway for anyone else to step in to introduce the service, as long as midwives can officially covcr that assessment. It does look as though the iniquitous 'one visit only' is to be the standard too, since the new birth visit is the only one that is described as a 'visit.' All other contacts can be through a variety of means, by a range of individuals and they mainly consist of a minimum programme of screening and immunisations. My first, fleeting impression is that there are some real opportunities here, but that it will be no more helpful to us than the Hall 4 document was: lots more talk about immunisations and GP training than other things, and quite an absence of understanding about the kind of relationship-based work that has been the focus of disucssion here on Senate over recent weeks. However, there is also much emphasis on clinical governance, quality and evidence based practice, and the overall thrust is very positive about children and families and parent support. I will keep trying to download the 'core standard' document, but will be pleased to here of views from anyone else who has succeeded, about this or any other parts of the NSF. kind regards margaret holtz wrote:

sheelah

please tell me this is not true! non-HV's doing new birth visits and needs assessment. Its only a matter of time really, when we all convince ourselves that quality doesn't matter, its only the health service, and i take it clinical governance agraid there were not risks involved? clients, practitioner or corporate.

i'd be interested in knowing more if you don't mind.

ta

mgt holtzSheelah Seeley <sheelah@...> wrote:

Dear

I had a brief look at some of it yesterday.

In the light of what is happening in Cambridge and elsewhere - i.e. non-health visitors doing the New Birth Visit - am I correct in interpreting the document as saying that visit MUST be a HV or midwife (under Overview of the Child Health Promotion Programme pg27 at the top and pg36 section 3.18 Assessing Needs and Intervening Early), or am I clutching at straws?

Sheelah

-----Original Message-----From: Cowley [mailto:sarah@...]Sent: Wed, 22 Sep 2004 09:24 Subject: Children's National Service FrameworkJust back from an excellent conference in Western Australia and trying to catch up a bit. I see the Children's NSF has been published; another mega-document, hard to download and hard to find on the DH website ( http://www.dh.gov.uk/Home/fs/en). The key seems to be put the whole title nto their web search document, which is: "National Service Framework for Children, Young People and Maternity Services: Core Standards" There are multiple variations on the theme: executive summary, documents for parents, children etc; very hard to find the one for professionals! kind regardssarah

ALL-NEW Messenger - all new features - even more fun!

[Guest guest]

Not sacrilege to me Ann; please let us have a discussion. I am sorry if

my terminology was insensitive or showed lack of knowledge of what happened

'on the ground.' Even though there has been a lot of water under the bridge

since the great cutbacks (which were at the base of the problems) I appreciate

that many people are still hurting so I should have been more careful; my

apologies.

I have heard of lots of places where activities that were once deemed so

difficult that only a qualified health visitor could do them are now being

undertaken very successfully by other team members, but under the clear guidance

of a health visitor if that is needed. Of course, there are many other professionals

that can equally guide and support for specific activities and perhaps it

is alright for midwives to oversee that 10-12 day family assessment; there

are certainly places where midwives do not hand over to HVs until after 28

days. I do not know of any research to show which timeframe works best,

which would be interesting to know.

However, I worry about how we can ensure the future of our profession when

there is so little recognition for it and no apparent requirement for a health

visiting qualification for anything specific any more. That is why I am

pleased that the NSF lays clear emphasis on the importance of the health

visiting team, in the primary care 'key issues' document. There is a requirement

for there to be a health visitor for each GP practice as well, and for the

handover from midwife to HV. Both of those requirements presume there will

be a health visiting service, which I think is good. Although individual

activities can be readily substituted (which was what was in my mind when

I used the word 'replace'), I do not believe that the skills that reside,

collectively, within health visiting exist, collectively, within any other

professional group, so I do not think families needs will be met as well

in future as they have been in the past, if we lose the knowledge and skill

of the health visiting profession. Perhaps that is professional protectionism,

but it is also about wondering how best to meet the needs of families.

You raise an important point, though, Ann. How do we have a debate about

retaining and enhancing professional skills in order to better meet the needs

of families, without sounding as though (on the one hand) we are writing

health visiting out of the equation, or (on the other) as if we are being

professionally protective? Does anyone have any suggestions, or thoughts

about the new guidance? Senate has not avoided difficult debates in the

past, so perhaps we can crack this one! best wishes

Ann Girling wrote:

Hi and anyone else who wants to

read this,

It's rarely that i wish to defend Lifespan

but health visitors were not replaced - they continue to exist and work

their socks off!! However a lot went on that was not so good and individuals

were treated very badly.

I also think health visitors have several

things to consider in terms of new birth visits. Firstly as says there

are not enough health visitors to go round so we do need to look at ways

of delivering the service in a different way.

Also having searched the literature I

have found none to support the new birth visit. Surely we need to consider

assessments which may be done at any time and should be carried out by a

qualifeid health visitor. Having assessed the needs of a family she can

then delegate appropriately within the team to those they deem competent

to perform the task.

Let's try and meet the needs of the families

and stop being professionally so defensive. I have a colleague who has had

a very difficult time because she has dared challenge custom and practice

and frankly that has sickened me. She is a young dynamic health visitor

and is likely to leave the profession because of these attitudes

I'm sure this will be considered sacrilege

to some but after all Senate is about debating the issues.

Ann

[Guest guest]

Here in Enfield i am constantly faced with the dilema, should my HVA be allowed to do a child health clinic without a Health Visitor? I would agree that in local community clinics, where a doctor, nurse may not be pesent, that an unqualified nurse may be at risk should an emergency arise, but in GP surgery settings where a GP, Practice nurse and others are present, in cases where the ususal HV is on leave, sick or on a course, then the HVA is safe to weigh, give standard advice, take messages to pass on to the HV (or colleague) or refer to the GP or practice nurse. Management are very protective of the HV in this instance. It means that my colleagues who are always stretched, have to drop their own work to cover something that works well without a HV, only 2-3 times a year, not every week or month. While I desperately do not want to see the demise of Health Visiting, but as mentioned by others, we are a hard to find breed these days, therefore I feel more, better, Health Visitor controlled skill mix may the answer. I have a vision for where I work, a new housing development (3500 dwellings) with a GP surgery, where the HV is the head of a team of professionals that include, child branch staff nurse, nursery nurse and HVA. This team would cross pollenate with the GP, practice nurse and school nurse, schools and residents association to improve the health and life chances of the local population. Surely this is where we need to head?? I think sometimes I work in a parallel world where good ideas are talked about but nothing happens!!!

[Guest guest]

Re the literature search which found no evidence to support the birth visit:

lack of evidence of effect is not evidence of lack of effect.

We should caution against practice decision making on such grounds.

I wonder what question was being asked in the search for evidence? There are

many attributes of a new birth visit. Perhaps we could begin by identifying

which outcomes with which skills health visitors are acheiving in the birth

visit that others could either be trained for or adapt to if necessary?

What happened to all those standards of practice and outcomes that were so

prolific a few years back?

Good debating!

Dr Coles PhD BA RHV RGN

Research Fellow

Department of Child Health, Community Section

Cardiff University, Wales College of Medicine

First Floor, Academic Centre

Llandough Hospital

Cardiff CF64 2XX

Telephone

Direct line/message service 02920 715479

Secretary 02920 716932/33/34

Fax 02920 350140

>>> sarah@... 23/09/04 10:35 PM >>>

Not sacrilege to me Ann; please let us have a discussion. I am sorry if

my terminology was insensitive or showed lack of knowledge of what

happened 'on the ground.' Even though there has been a lot of water

under the bridge since the great cutbacks (which were at the base of the

problems) I appreciate that many people are still hurting so I should

have been more careful; my apologies.

I have heard of lots of places where activities that were once deemed so

difficult that only a qualified health visitor could do them are now

being undertaken very successfully by other team members, but under the

clear guidance of a health visitor if that is needed. Of course, there

are many other professionals that can equally guide and support for

specific activities and perhaps it is alright for midwives to oversee

that 10-12 day family assessment; there are certainly places where

midwives do not hand over to HVs until after 28 days. I do not know of

any research to show which timeframe works best, which would be

interesting to know.

However, I worry about how we can ensure the future of our profession

when there is so little recognition for it and no apparent requirement

for a health visiting qualification for anything specific any more.

That is why I am pleased that the NSF lays clear emphasis on the

importance of the health visiting team, in the primary care 'key issues'

document. There is a requirement for there to be a health visitor for

each GP practice as well, and for the handover from midwife to HV. Both

of those requirements presume there will be a health visiting service,

which I think is good. Although individual activities can be readily

substituted (which was what was in my mind when I used the word

'replace'), I do not believe that the skills that reside, collectively,

within health visiting exist, collectively, within any other

professional group, so I do not think families needs will be met as well

in future as they have been in the past, if we lose the knowledge and

skill of the health visiting profession. Perhaps that is professional

protectionism, but it is also about wondering how best to meet the needs

of families.

You raise an important point, though, Ann. How do we have a debate

about retaining and enhancing professional skills in order to better

meet the needs of families, without sounding as though (on the one hand)

we are writing health visiting out of the equation, or (on the other)

as if we are being professionally protective? Does anyone have any

suggestions, or thoughts about the new guidance? Senate has not avoided

difficult debates in the past, so perhaps we can crack this one! best

wishes

Ann Girling wrote:

> Hi and anyone else who wants to read this,

>

> It's rarely that i wish to defend Lifespan but health visitors were

> not replaced - they continue to exist and work their socks off!!

> However a lot went on that was not so good and individuals were

> treated very badly.

>

> I also think health visitors have several things to consider in terms

> of new birth visits. Firstly as says there are not enough health

> visitors to go round so we do need to look at ways of delivering the

> service in a different way.

>

> Also having searched the literature I have found none to support the

> new birth visit. Surely we need to consider assessments which may be

> done at any time and should be carried out by a qualifeid health

> visitor. Having assessed the needs of a family she can then delegate

> appropriately within the team to those they deem competent to perform

> the task.

>

> Let's try and meet the needs of the families and stop being

> professionally so defensive. I have a colleague who has had a very

> difficult time because she has dared challenge custom and practice and

> frankly that has sickened me. She is a young dynamic health visitor

> and is likely to leave the profession because of these attitudes

>

> I'm sure this will be considered sacrilege to some but after all

> Senate is about debating the issues.

>

> Ann

>

[Guest guest]

It is not just a vision –

it is happening. We are working with education staff in teams of health

visitors/school nurses in community clusters around school pyramids and soon to

be joined by social care, youth offending, primary mental health workers etc.

Exciting times, don’t just dream, get us all together.

-----Original

Message-----

From: kms160360@...

[mailto:kms160360@...]

Sent: 24 September 2004 09:41

Subject: Re:

Children's National Service Framework

Here in

Enfield i am constantly faced with the dilema, should my HVA be allowed to do a

child health clinic without a Health Visitor? I would agree that in local

community clinics, where a doctor, nurse may not be pesent, that an unqualified

nurse may be at risk should an emergency arise, but in GP surgery settings

where a GP, Practice nurse and others are present, in cases where the ususal HV

is on leave, sick or on a course, then the HVA is safe to weigh, give standard

advice, take messages to pass on to the HV (or colleague) or refer to the GP or

practice nurse. Management are very protective of the HV in this instance. It

means that my colleagues who are always stretched, have to drop their own work

to cover something that works well without a HV, only 2-3 times a year, not

every week or month. While I desperately do not want to see the demise of

Health Visiting, but as mentioned by others, we are a hard to find breed these

days, therefore I feel more, better, Health Visitor controlled skill mix may

the answer. I have a vision for where I work, a new housing development (3500

dwellings) with a GP surgery, where the HV is the head of a team of

professionals that include, child branch staff nurse, nursery nurse and HVA.

This team would cross pollenate with the GP, practice nurse and school

nurse, schools and residents association to improve the health and life chances

of the local population. Surely this is where we need to head?? I think

sometimes I work in a parallel world where good ideas are talked about but

nothing happens!!!

[Guest guest]

I didn't say who I was, sorry. Where are these dreams happening? I would be interested to speak to you. My e-mail at work is kathy.soderquist@... many thanks Kathy

[Guest guest]

Surely this is all about delegation and developing competencies within the team to meet the needs of the population. For some time i used to have a nursery nurse run the clinic for me when i was extremely hard pressed. She was more than competent and would refer back to me when necessary... and what a relief it was for me

Ann

Re: Children's National Service Framework

Here in Enfield i am constantly faced with the dilema, should my HVA be allowed to do a child health clinic without a Health Visitor? I would agree that in local community clinics, where a doctor, nurse may not be pesent, that an unqualified nurse may be at risk should an emergency arise, but in GP surgery settings where a GP, Practice nurse and others are present, in cases where the ususal HV is on leave, sick or on a course, then the HVA is safe to weigh, give standard advice, take messages to pass on to the HV (or colleague) or refer to the GP or practice nurse. Management are very protective of the HV in this instance. It means that my colleagues who are always stretched, have to drop their own work to cover something that works well without a HV, only 2-3 times a year, not every week or month. While I desperately do not want to see the demise of Health Visiting, but as mentioned by others, we are a hard to find breed these days, therefore I feel more, better, Health Visitor controlled skill mix may the answer. I have a vision for where I work, a new housing development (3500 dwellings) with a GP surgery, where the HV is the head of a team of professionals that include, child branch staff nurse, nursery nurse and HVA. This team would cross pollenate with the GP, practice nurse and school nurse, schools and residents association to improve the health and life chances of the local population. Surely this is where we need to head?? I think sometimes I work in a parallel world where good ideas are talked about but nothing happens!!!

[Guest guest]

Thanks . Yes a lot of peole are still hurting and I think personally disinvestment probably started the road that ended with me leaving health visiting or at least my role within cambridge and frankly i would have a problem being employed again - i have lost faith and trust. However some of it has been restored by meeting some great people in my self employed role (Jane, are you reading this?)

I feel very passionately still about health vsiting and beoieve that asesemnt is not focused on one visit. As it says in the NSF it is ongoing. I think it might be excellent for the midwife, HV or whoever to do the primary visit dep[ending on what is appropriate for the individual family and ensuring their needs are asessed appropriately. My concern for the profesion is that we are in danger of alienating others ie stautory and voluntary agencies, managers, even the population we serve if we cling to custom and practice ways of working. This was reinforced by Neil Brocklehurst in one of his recent articles in Community Practitioner. he also pointed out that the field of home visiting is a hugely contested one now and we need to be clear about what it is we hope to achieve and as it is well documented health visitors are not great at articulating their objectives.

Reflective practice is a means in which we can start to articluate health visiting practice - we just need to make greater use of it

Ann

Re: Children's National Service Framework

Not sacrilege to me Ann; please let us have a discussion. I am sorry if my terminology was insensitive or showed lack of knowledge of what happened 'on the ground.' Even though there has been a lot of water under the bridge since the great cutbacks (which were at the base of the problems) I appreciate that many people are still hurting so I should have been more careful; my apologies. I have heard of lots of places where activities that were once deemed so difficult that only a qualified health visitor could do them are now being undertaken very successfully by other team members, but under the clear guidance of a health visitor if that is needed. Of course, there are many other professionals that can equally guide and support for specific activities and perhaps it is alright for midwives to oversee that 10-12 day family assessment; there are certainly places where midwives do not hand over to HVs until after 28 days. I do not know of any research to show which timeframe works best, which would be interesting to know. However, I worry about how we can ensure the future of our profession when there is so little recognition for it and no apparent requirement for a health visiting qualification for anything specific any more. That is why I am pleased that the NSF lays clear emphasis on the importance of the health visiting team, in the primary care 'key issues' document. There is a requirement for there to be a health visitor for each GP practice as well, and for the handover from midwife to HV. Both of those requirements presume there will be a health visiting service, which I think is good. Although individual activities can be readily substituted (which was what was in my mind when I used the word 'replace'), I do not believe that the skills that reside, collectively, within health visiting exist, collectively, within any other professional group, so I do not think families needs will be met as well in future as they have been in the past, if we lose the knowledge and skill of the health visiting profession. Perhaps that is professional protectionism, but it is also about wondering how best to meet the needs of families. You raise an important point, though, Ann. How do we have a debate about retaining and enhancing professional skills in order to better meet the needs of families, without sounding as though (on the one hand) we are writing health visiting out of the equation, or (on the other) as if we are being professionally protective? Does anyone have any suggestions, or thoughts about the new guidance? Senate has not avoided difficult debates in the past, so perhaps we can crack this one! best wishesAnn Girling wrote:

Hi and anyone else who wants to read this,

It's rarely that i wish to defend Lifespan but health visitors were not replaced - they continue to exist and work their socks off!! However a lot went on that was not so good and individuals were treated very badly.

I also think health visitors have several things to consider in terms of new birth visits. Firstly as says there are not enough health visitors to go round so we do need to look at ways of delivering the service in a different way.

Also having searched the literature I have found none to support the new birth visit. Surely we need to consider assessments which may be done at any time and should be carried out by a qualifeid health visitor. Having assessed the needs of a family she can then delegate appropriately within the team to those they deem competent to perform the task.

Let's try and meet the needs of the families and stop being professionally so defensive. I have a colleague who has had a very difficult time because she has dared challenge custom and practice and frankly that has sickened me. She is a young dynamic health visitor and is likely to leave the profession because of these attitudes

I'm sure this will be considered sacrilege to some but after all Senate is about debating the issues.

Ann

[Guest guest]

I think many of us know how and why you feel the way that you do Ann. Some

PCT managers have little understanding of a parent adviser role and

consequently ravage it.If one is passionate about health visiting values it

is very traumatic I know.However perhaps it means that you are ready to move

in another direction. Studying at doctoral level has certainly helped me to

come to terms with health visiting as well as myself.Have you thought of

going on after your Masters?Regards, Ann

>From: " Ann Girling " <ann.25@...>

>Reply-

>< >

>Subject: Re: Children's National Service Framework

>Date: Sat, 25 Sep 2004 15:26:41 +0100

>

>Thanks . Yes a lot of peole are still hurting and I think personally

>disinvestment probably started the road that ended with me leaving health

>visiting or at least my role within cambridge and frankly i would have a

>problem being employed again - i have lost faith and trust. However some of

>it has been restored by meeting some great people in my self employed role

>(Jane, are you reading this?)

>

>I feel very passionately still about health vsiting and beoieve that

>asesemnt is not focused on one visit. As it says in the NSF it is ongoing.

>I think it might be excellent for the midwife, HV or whoever to do the

>primary visit dep[ending on what is appropriate for the individual family

>and ensuring their needs are asessed appropriately. My concern for the

>profesion is that we are in danger of alienating others ie stautory and

>voluntary agencies, managers, even the population we serve if we cling to

>custom and practice ways of working. This was reinforced by Neil

>Brocklehurst in one of his recent articles in Community Practitioner. he

>also pointed out that the field of home visiting is a hugely contested one

>now and we need to be clear about what it is we hope to achieve and as it

>is well documented health visitors are not great at articulating their

>objectives.

>

>Reflective practice is a means in which we can start to articluate health

>visiting practice - we just need to make greater use of it

>

>Ann

> Re: Children's National Service Framework

>

>

> Not sacrilege to me Ann; please let us have a discussion. I am sorry if

>my terminology was insensitive or showed lack of knowledge of what happened

>'on the ground.' Even though there has been a lot of water under the

>bridge since the great cutbacks (which were at the base of the problems) I

>appreciate that many people are still hurting so I should have been more

>careful; my apologies.

>

> I have heard of lots of places where activities that were once deemed so

>difficult that only a qualified health visitor could do them are now being

>undertaken very successfully by other team members, but under the clear

>guidance of a health visitor if that is needed. Of course, there are many

>other professionals that can equally guide and support for specific

>activities and perhaps it is alright for midwives to oversee that 10-12 day

>family assessment; there are certainly places where midwives do not hand

>over to HVs until after 28 days. I do not know of any research to show

>which timeframe works best, which would be interesting to know.

>

> However, I worry about how we can ensure the future of our profession

>when there is so little recognition for it and no apparent requirement for

>a health visiting qualification for anything specific any more. That is

>why I am pleased that the NSF lays clear emphasis on the importance of the

>health visiting team, in the primary care 'key issues' document. There is

>a requirement for there to be a health visitor for each GP practice as

>well, and for the handover from midwife to HV. Both of those requirements

>presume there will be a health visiting service, which I think is good.

>Although individual activities can be readily substituted (which was what

>was in my mind when I used the word 'replace'), I do not believe that the

>skills that reside, collectively, within health visiting exist,

>collectively, within any other professional group, so I do not think

>families needs will be met as well in future as they have been in the past,

>if we lose the knowledge and skill of the health visiting profession.

>Perhaps that is professional protectionism, but it is also about wondering

>how best to meet the needs of families.

>

> You raise an important point, though, Ann. How do we have a debate

>about retaining and enhancing professional skills in order to better meet

>the needs of families, without sounding as though (on the one hand) we are

>writing health visiting out of the equation, or (on the other) as if we

>are being professionally protective? Does anyone have any suggestions, or

>thoughts about the new guidance? Senate has not avoided difficult debates

>in the past, so perhaps we can crack this one! best wishes

>

>

>

>

> Ann Girling wrote:

>

> Hi and anyone else who wants to read this,

>

> It's rarely that i wish to defend Lifespan but health visitors were

>not replaced - they continue to exist and work their socks off!! However a

>lot went on that was not so good and individuals were treated very badly.

>

> I also think health visitors have several things to consider in terms

>of new birth visits. Firstly as says there are not enough health

>visitors to go round so we do need to look at ways of delivering the

>service in a different way.

>

> Also having searched the literature I have found none to support the

>new birth visit. Surely we need to consider assessments which may be done

>at any time and should be carried out by a qualifeid health visitor. Having

>assessed the needs of a family she can then delegate appropriately within

>the team to those they deem competent to perform the task.

>

> Let's try and meet the needs of the families and stop being

>professionally so defensive. I have a colleague who has had a very

>difficult time because she has dared challenge custom and practice and

>frankly that has sickened me. She is a young dynamic health visitor and is

>likely to leave the profession because of these attitudes

>

> I'm sure this will be considered sacrilege to some but after all

>Senate is about debating the issues.

>

> Ann

>

>

>

[Guest guest]

A PHD is definitelt not on my agenda - it's time for me now .. and a very

patient husband!!

Ann

Re: Children's National Service Framework

>>

>>

>> Not sacrilege to me Ann; please let us have a discussion. I am sorry

>> if

>>my terminology was insensitive or showed lack of knowledge of what

>>happened

>>'on the ground.' Even though there has been a lot of water under the

>>bridge since the great cutbacks (which were at the base of the problems) I

>>appreciate that many people are still hurting so I should have been more

>>careful; my apologies.

>>

>> I have heard of lots of places where activities that were once deemed

>> so

>>difficult that only a qualified health visitor could do them are now being

>>undertaken very successfully by other team members, but under the clear

>>guidance of a health visitor if that is needed. Of course, there are many

>>other professionals that can equally guide and support for specific

>>activities and perhaps it is alright for midwives to oversee that 10-12

>>day

>>family assessment; there are certainly places where midwives do not hand

>>over to HVs until after 28 days. I do not know of any research to show

>>which timeframe works best, which would be interesting to know.

>>

>> However, I worry about how we can ensure the future of our profession

>>when there is so little recognition for it and no apparent requirement for

>>a health visiting qualification for anything specific any more. That is

>>why I am pleased that the NSF lays clear emphasis on the importance of the

>>health visiting team, in the primary care 'key issues' document. There is

>>a requirement for there to be a health visitor for each GP practice as

>>well, and for the handover from midwife to HV. Both of those requirements

>>presume there will be a health visiting service, which I think is good.

>>Although individual activities can be readily substituted (which was what

>>was in my mind when I used the word 'replace'), I do not believe that the

>>skills that reside, collectively, within health visiting exist,

>>collectively, within any other professional group, so I do not think

>>families needs will be met as well in future as they have been in the

>>past,

>>if we lose the knowledge and skill of the health visiting profession.

>>Perhaps that is professional protectionism, but it is also about wondering

>>how best to meet the needs of families.

>>

>> You raise an important point, though, Ann. How do we have a debate

>>about retaining and enhancing professional skills in order to better meet

>>the needs of families, without sounding as though (on the one hand) we are

>>writing health visiting out of the equation, or (on the other) as if we

>>are being professionally protective? Does anyone have any suggestions, or

>>thoughts about the new guidance? Senate has not avoided difficult debates

>>in the past, so perhaps we can crack this one! best wishes

>>

>>

>>

>>

>> Ann Girling wrote:

>>

>> Hi and anyone else who wants to read this,

>>

>> It's rarely that i wish to defend Lifespan but health visitors were

>>not replaced - they continue to exist and work their socks off!! However a

>>lot went on that was not so good and individuals were treated very badly.

>>

>> I also think health visitors have several things to consider in terms

>>of new birth visits. Firstly as says there are not enough health

>>visitors to go round so we do need to look at ways of delivering the

>>service in a different way.

>>

>> Also having searched the literature I have found none to support the

>>new birth visit. Surely we need to consider assessments which may be done

>>at any time and should be carried out by a qualifeid health visitor.

>>Having

>>assessed the needs of a family she can then delegate appropriately within

>>the team to those they deem competent to perform the task.

>>

>> Let's try and meet the needs of the families and stop being

>>professionally so defensive. I have a colleague who has had a very

>>difficult time because she has dared challenge custom and practice and

>>frankly that has sickened me. She is a young dynamic health visitor and is

>>likely to leave the profession because of these attitudes

>>

>> I'm sure this will be considered sacrilege to some but after all

>>Senate is about debating the issues.

>>

>> Ann

>>

>>

>>

[Guest guest]

I think it's a matter of what you want done in a clinic. If it's case of task like weighing, noting on a percentile chart, issuing advice based on this, it seems to be something pretty automatic. I'd have no problem with an HVA doing this sort of clinic. If the clinic is essentially being managed by a doctor and nurse, with the HV simply an added service, perhaps the main reason a parent would take a child is attending for routine immunisation or a physical checkup and only need to know about what to expect. Again, why not an HVA? Some clinics are crowded, there isn't much privacy or time for discussion.

But if it's important to note something more such as behaviour assessment, developmental progress or weaning food intake discussion and if perhaps the mother's questions aren't easy to predict, perhaps a bit more flexibility in approach or a bit of clinical judgement is needed. It depends. Some clinics might be really challenging professionally, perhaps.

-----Original Message-----From: kms160360@... [mailto:kms160360@...] Sent: 24 September 2004 09:41 Subject: Re: Children's National Service Framework

Here in Enfield i am constantly faced with the dilema, should my HVA be allowed to do a child health clinic without a Health Visitor? I would agree that in local community clinics, where a doctor, nurse may not be pesent, that an unqualified nurse may be at risk should an emergency arise, but in GP surgery settings where a GP, Practice nurse and others are present, in cases where the ususal HV is on leave, sick or on a course, then the HVA is safe to weigh, give standard advice, take messages to pass on to the HV (or colleague) or refer to the GP or practice nurse. Management are very protective of the HV in this instance. It means that my colleagues who are always stretched, have to drop their own work to cover something that works well without a HV, only 2-3 times a year, not every week or month. While I desperately do not want to see the demise of Health Visiting, but as mentioned by others, we are a hard to find breed these days, therefore I feel more, better, Health Visitor controlled skill mix may the answer. I have a vision for where I work, a new housing development (3500 dwellings) with a GP surgery, where the HV is the head of a team of professionals that include, child branch staff nurse, nursery nurse and HVA. This team would cross pollenate with the GP, practice nurse and school nurse, schools and residents association to improve the health and life chances of the local population. Surely this is where we need to head?? I think sometimes I work in a parallel world where good ideas are talked about but nothing happens!!!

[Guest guest]

What a relief to hear. At times I have been made to feel that I am not only letting the profession down, but the clients for not providing a good enough service. Thanks

[Guest guest]

Hi Ann

I agree with you 100%. Let’s move on

and meet the needs of families working with all partners to deliver solutions

to those needs, sharing pooled budgets to achieve optimum impact.

Penny

Re:

Children's National Service Framework

Hi and anyone else who wants

to read this,

It's rarely that i wish to defend

Lifespan but health visitors were not replaced - they continue to exist and

work their socks off!! However a lot went on that was not so good and

individuals were treated very badly.

I also think health

visitors have several things to consider in terms of new birth visits.

Firstly as says there are not enough health visitors to go

round so we do need to look at ways of delivering the service in a

different way.

Also having searched the literature

I have found none to support the new birth visit. Surely we need to

consider assessments which may be done at any time and should be carried out by

a qualifeid health visitor. Having assessed the needs of a family she can

then delegate appropriately within the team to those they deem competent to

perform the task.

Let's try and meet the needs of the

families and stop being professionally so defensive. I have a colleague who has

had a very difficult time because she has dared challenge custom and practice

and frankly that has sickened me. She is a young dynamic health

visitor and is likely to leave the profession because of these attitudes

I'm sure this will be considered

sacrilege to some but after all Senate is about debating the issues.

Ann

Children's

National Service Framework

Just back from an excellent conference in Western

Australia and trying to catch up a bit. I see the Children's NSF has been

published; another mega-document, hard to download and hard to find on the DH

website ( http://www.dh.gov.uk/Home/fs/en).

The key seems to be put the whole title nto their web search document,

which is:

" National

Service Framework for Children, Young People and Maternity Services: Core

Standards " There are multiple variations on the theme:

executive summary, documents for parents, children etc; very hard to find

the one for professionals!

kind regards

sarah

ALL-NEW Messenger - all new

features - even more fun!

---

Incoming mail is certified Virus Free.

Checked by AVG anti-virus system (http://www.grisoft.com).

Version: 6.0.755 / Virus Database: 505 - Release Date: 08/09/2004

---

Outgoing mail is certified Virus Free.

Checked by AVG anti-virus system (http://www.grisoft.com).

Version: 6.0.755 / Virus Database: 505 - Release Date: 08/09/2004

[Guest guest]

Barbara - to the list we can add - Connexions, Police, Youth & Community, Youth Offending Team, Community Safety, Lifelong Learning, and a multitude of others both statutory and voluntary. I too think that HVs need to get working across boundaries for their population.

Ruth

RE: Children's National Service Framework

It is not just a vision – it is happening. We are working with education staff in teams of health visitors/school nurses in community clusters around school pyramids and soon to be joined by social care, youth offending, primary mental health workers etc. Exciting times, don’t just dream, get us all together.

-----Original Message-----From: kms160360@... [mailto:kms160360@...] Sent: 24 September 2004 09:41 Subject: Re: Children's National Service Framework

Here in Enfield i am constantly faced with the dilema, should my HVA be allowed to do a child health clinic without a Health Visitor? I would agree that in local community clinics, where a doctor, nurse may not be pesent, that an unqualified nurse may be at risk should an emergency arise, but in GP surgery settings where a GP, Practice nurse and others are present, in cases where the ususal HV is on leave, sick or on a course, then the HVA is safe to weigh, give standard advice, take messages to pass on to the HV (or colleague) or refer to the GP or practice nurse. Management are very protective of the HV in this instance. It means that my colleagues who are always stretched, have to drop their own work to cover something that works well without a HV, only 2-3 times a year, not every week or month. While I desperately do not want to see the demise of Health Visiting, but as mentioned by others, we are a hard to find breed these days, therefore I feel more, better, Health Visitor controlled skill mix may the answer. I have a vision for where I work, a new housing development (3500 dwellings) with a GP surgery, where the HV is the head of a team of professionals that include, child branch staff nurse, nursery nurse and HVA. This team would cross pollenate with the GP, practice nurse and school nurse, schools and residents association to improve the health and life chances of the local population. Surely this is where we need to head?? I think sometimes I work in a parallel world where good ideas are talked about but nothing happens!!!

[Guest guest]

To applify 's point, it is also important to know whether there

has been research specifically on the first visit which didn't show

benefits, or whether the research hasn't been done. If there hasn't

been research, then managers should be highlighting the need (?to

SDO) rather than abandoning the practice.

<sarah@...>,< >

From: " Coles " <colesew@...>

Date sent: Fri, 24 Sep 2004 08:57:47 +0100

Subject: Re: Children's National Service Framework

Send reply to:

[ Double-click this line for list subscription options ]

Re the literature search which found no evidence to support the birth visit:

lack of evidence of effect is not evidence of lack of effect.

We should caution against practice decision making on such grounds.

I wonder what question was being asked in the search for evidence? There are

many attributes of a new birth visit. Perhaps we could begin by identifying

which outcomes with which skills health visitors are acheiving in the birth

visit that others could either be trained for or adapt to if necessary?

What happened to all those standards of practice and outcomes that were so

prolific a few years back?

Good debating!

Dr Coles PhD BA RHV RGN

Research Fellow

Department of Child Health, Community Section

Cardiff University, Wales College of Medicine

First Floor, Academic Centre

Llandough Hospital

Cardiff CF64 2XX

Telephone

Direct line/message service 02920 715479

Secretary 02920 716932/33/34

Fax 02920 350140

>>> sarah@... 23/09/04 10:35 PM >>>

Not sacrilege to me Ann; please let us have a discussion. I am sorry if

my terminology was insensitive or showed lack of knowledge of what

happened 'on the ground.' Even though there has been a lot of water

under the bridge since the great cutbacks (which were at the base of the

problems) I appreciate that many people are still hurting so I should

have been more careful; my apologies.

I have heard of lots of places where activities that were once deemed so

difficult that only a qualified health visitor could do them are now

being undertaken very successfully by other team members, but under the

clear guidance of a health visitor if that is needed. Of course, there

are many other professionals that can equally guide and support for

specific activities and perhaps it is alright for midwives to oversee

that 10-12 day family assessment; there are certainly places where

midwives do not hand over to HVs until after 28 days. I do not know of

any research to show which timeframe works best, which would be

interesting to know.

However, I worry about how we can ensure the future of our profession

when there is so little recognition for it and no apparent requirement

for a health visiting qualification for anything specific any more.

That is why I am pleased that the NSF lays clear emphasis on the

importance of the health visiting team, in the primary care 'key issues'

document. There is a requirement for there to be a health visitor for

each GP practice as well, and for the handover from midwife to HV. Both

of those requirements presume there will be a health visiting service,

which I think is good. Although individual activities can be readily

substituted (which was what was in my mind when I used the word

'replace'), I do not believe that the skills that reside, collectively,

within health visiting exist, collectively, within any other

professional group, so I do not think families needs will be met as well

in future as they have been in the past, if we lose the knowledge and

skill of the health visiting profession. Perhaps that is professional

protectionism, but it is also about wondering how best to meet the needs

of families.

You raise an important point, though, Ann. How do we have a debate

about retaining and enhancing professional skills in order to better

meet the needs of families, without sounding as though (on the one hand)

we are writing health visiting out of the equation, or (on the other)

as if we are being professionally protective? Does anyone have any

suggestions, or thoughts about the new guidance? Senate has not avoided

difficult debates in the past, so perhaps we can crack this one! best

wishes

Ann Girling wrote:

> Hi and anyone else who wants to read this,

>

> It's rarely that i wish to defend Lifespan but health visitors were

> not replaced - they continue to exist and work their socks off!!

> However a lot went on that was not so good and individuals were

> treated very badly.

>

> I also think health visitors have several things to consider in terms

> of new birth visits. Firstly as says there are not enough health

> visitors to go round so we do need to look at ways of delivering the

> service in a different way.

>

> Also having searched the literature I have found none to support the

> new birth visit. Surely we need to consider assessments which may be

> done at any time and should be carried out by a qualifeid health

> visitor. Having assessed the needs of a family she can then delegate

> appropriately within the team to those they deem competent to perform

> the task.

>

> Let's try and meet the needs of the families and stop being

> professionally so defensive. I have a colleague who has had a very

> difficult time because she has dared challenge custom and practice and

> frankly that has sickened me. She is a young dynamic health visitor

> and is likely to leave the profession because of these attitudes

>

> I'm sure this will be considered sacrilege to some but after all

> Senate is about debating the issues.

>

> Ann

>

[Guest guest]

Agree it would be useful to have a comparator study between HVs

and MWs providing early support. I haven't read the RCT referred

to, but did it discuss labour markets at all? Since midwifery is also

a shortage discipline, and from what I gather women often don't get

the choice they should in the actual delivery because of midwife

shortages, there's an important opportunity cost if midwives are

extending their visiting period, which needs to be taken into

account.

From: Cowley <sarah@...>

Date sent: Thu, 23 Sep 2004 22:35:42 +0100

Subject: Re: Children's National Service Framework

Send reply to:

[ Double-click this line for list subscription options ]

Not sacrilege to me Ann; please let us have a discussion. I am sorry if

my terminology was insensitive or showed lack of knowledge of what

happened 'on the ground.' Even though there has been a lot of water

under the bridge since the great cutbacks (which were at the base of the

problems) I appreciate that many people are still hurting so I should

have been more careful; my apologies.

I have heard of lots of places where activities that were once deemed so

difficult that only a qualified health visitor could do them are now

being undertaken very successfully by other team members, but under the

clear guidance of a health visitor if that is needed. Of course, there

are many other professionals that can equally guide and support for

specific activities and perhaps it is alright for midwives to oversee

that 10-12 day family assessment; there are certainly places where

midwives do not hand over to HVs until after 28 days. I do not know of

any research to show which timeframe works best, which would be

interesting to know.

However, I worry about how we can ensure the future of our profession

when there is so little recognition for it and no apparent requirement

for a health visiting qualification for anything specific any more.

That is why I am pleased that the NSF lays clear emphasis on the

importance of the health visiting team, in the primary care 'key issues'

document. There is a requirement for there to be a health visitor for

each GP practice as well, and for the handover from midwife to HV. Both

of those requirements presume there will be a health visiting service,

which I think is good. Although individual activities can be readily

substituted (which was what was in my mind when I used the word

'replace'), I do not believe that the skills that reside, collectively,

within health visiting exist, collectively, within any other

professional group, so I do not think families needs will be met as well

in future as they have been in the past, if we lose the knowledge and

skill of the health visiting profession. Perhaps that is professional

protectionism, but it is also about wondering how best to meet the needs

of families.

You raise an important point, though, Ann. How do we have a debate

about retaining and enhancing professional skills in order to better

meet the needs of families, without sounding as though (on the one hand)

we are writing health visiting out of the equation, or (on the other)

as if we are being professionally protective? Does anyone have any

suggestions, or thoughts about the new guidance? Senate has not avoided

difficult debates in the past, so perhaps we can crack this one! best

wishes

Ann Girling wrote:

> Hi and anyone else who wants to read this,

>

> It's rarely that i wish to defend Lifespan but health visitors were

> not replaced - they continue to exist and work their socks off!!

> However a lot went on that was not so good and individuals were

> treated very badly.

>

> I also think health visitors have several things to consider in terms

> of new birth visits. Firstly as says there are not enough health

> visitors to go round so we do need to look at ways of delivering the

> service in a different way.

>

> Also having searched the literature I have found none to support the

> new birth visit. Surely we need to consider assessments which may be

> done at any time and should be carried out by a qualifeid health

> visitor. Having assessed the needs of a family she can then delegate

> appropriately within the team to those they deem competent to perform

> the task.

>

> Let's try and meet the needs of the families and stop being

> professionally so defensive. I have a colleague who has had a very

> difficult time because she has dared challenge custom and practice and

> frankly that has sickened me. She is a young dynamic health visitor

> and is likely to leave the profession because of these attitudes

>

> I'm sure this will be considered sacrilege to some but after all

> Senate is about debating the issues.

>

> Ann

>

Professor Liz Meerabeau

Head of the School of Health and Social Care

University of Greenwich

Avery Hill Campus

Southwood Site

Avery Hill Road

London SE9 2UG

020 8331 9150

020 8331 8060 (fax)

E.Meerabeau@...

[Guest guest]

Sorry, I'm just catching up on the debate. I was a bit puzzled by Ann's earlier assertion that having searched the literature she found none to support the new birth visit, and that we need to consider assessments which may be done at any time and should be carried out by a qualified health visitor.

How will we know when it is the right time to assess a family if we don't know them from the new birth at least, and surely we are helping to meet the needs of families by doing a new birth visit? That is usually the time they are at their most vulnerable. Most, in my experience are grateful to see the HV after they have had a new baby, especially a first time mum. Only recently I did a follow up visit to an affluent American mum with a third baby who had several problems. She mentioned that there had been lots of discussions in American magazines about the British system of Midwives and HVs visiting new mums after birth instead of leaving them to get on with it, and how envious they were of this, and wanted it themselves. Perhaps instead of searching the literature for support of the new birth visit we should be asking mums how they feel about it instead?

I also work with a team of nursery nurses who are excellent in lots of ways and who also run some quietCHCs if the HV is not available,and I certainly use them to follow up behaviour problems with toddlers and for teaching mums play skills etc. However, in my experience they just don't usually have the lateral thinking and ability to see further than the immediate presenting problem, that HVs have. For exampe one NN did a visit to talk to the mum about play with her toddler but didn't pick up on the fact that the child had very little speech because that wasn't on her agenda. I'm sure this lack of awareness of the wider agenda could lead to problems being missed at the NBV, and at CHCs however well NN are taught.

Finally, regarding the debate about midwives visiting up to 28 days -haven't we been here before some years ago? Where are all these midwives who are going to visit for 28 days coming from? Certainly where I work, new mums may only get one or two visits from the community midwife in the first 10 days because they are so short staffed, and I have recently had to help 4 breastfeeding mums with latching on and other feeding problems at the NBV, becasue the midwife didn't have time. Only recently too I met a new mum in clinic who was trying to breastfeed but whose baby was given formula in the well known hospital she gave birth in because the midwife told her they were too short staffed to teach her to breastfeed.

June

[Guest guest]

Ruth

I do so agree with you. The way forward is sharing, working together and acknowledging that everyone has something to contribute.

I have been running courses in Perinatal mental health for many years now and in the past 2-3 years these have become much more multidisciplinary. Sure Start started this for me and I have found some truly inspirational non-health professionals doing the job/business as well as qualified people.

However, we do need people who work across the life-span, who have been through a rigorous training with well-honed competencies and experience etc . I am afraid I still have this (paranoid) thought that health visiting/visitors is/are being written out of the script.(viz. NSF for Children etc - extended midwifery)

Sheelah

-----Original Message-----From: Ruth Grant [mailto:ruth@...]Sent: Mon, 27 Sep 2004 21:57 Subject: Re: Children's National Service Framework

Barbara - to the list we can add - Connexions, Police, Youth & Community, Youth Offending Team, Community Safety, Lifelong Learning, and a multitude of others both statutory and voluntary. I too think that HVs need to get working across boundaries for their population.

Ruth

RE: Children's National Service Framework

It is not just a vision – it is happening. We are working with education staff in teams of health visitors/school nurses in community clusters around school pyramids and soon to be joined by social care, youth offending, primary mental health workers etc. Exciting times, don’t just dream, get us all together.

-----Original Message-----From: kms160360@... [mailto:kms160360@...] Sent: 24 September 2004 09:41 Subject: Re: Children's National Service Framework

Here in Enfield i am constantly faced with the dilema, should my HVA be allowed to do a child health clinic without a Health Visitor? I would agree that in local community clinics, where a doctor, nurse may not be pesent, that an unqualified nurse may be at risk should an emergency arise, but in GP surgery settings where a GP, Practice nurse and others are present, in cases where the ususal HV is on leave, sick or on a course, then the HVA is safe to weigh, give standard advice, take messages to pass on to the HV (or colleague) or refer to the GP or practice nurse. Management are very protective of the HV in this instance. It means that my colleagues who are always stretched, have to drop their own work to cover something that works well without a HV, only 2-3 times a year, not every week or month. While I desperately do not want to see the demise of Health Visiting, but as mentioned by others, we are a hard to find breed these days, therefore I feel more, better, Health Visitor controlled skill mix may the answer. I have a vision for where I work, a new housing development (3500 dwellings) with a GP surgery, where the HV is the head of a team of professionals that include, child branch staff nurse, nursery nurse and HVA. This team would cross pollenate with the GP, practice nurse and school nurse, schools and residents association to improve the health and life chances of the local population. Surely this is where we need to head?? I think sometimes I work in a parallel world where good ideas are talked about but nothing happens!!!

[Guest guest]

This all sounds very familiar to me. Our midwives are in the same position. The point about the nursery nurse though, I have to defend mine, she would have picked up the speech problem. I'm sure it comes down to training and experience, after all NN's are relatively new to Health Visiting services. Kathy Soderquist

[Guest guest]

I'm not suggesting that the new birth visit is not important, i believ it is but I don't think it is the be all and end all. having worked with some very strange and unhlepful guidelines eg having to do it within 10-14 days and seeing staff struggling to comply with that when the midwife may still be visiting and worrying about hips, perineums etc etc which have been done to death instead of what is more importnat, the holistic approach to the health and well being of the new family.

But this is not the only time we assess a family's needs - should we not be attempting to start this assessment and identify health needs in the ante-natal period or when a family moves in. I may be stating the obvious (I know I am) but despite all this the same traditional custom and practice continues unquestioned. June, I know the new birth visit is important but I couldn't find evidence to support it when i looked for it so surely we need to be providing it and maybe health visitors' "practice stories" can do just that

Ann

Re: Children's National Service Framework

Sorry, I'm just catching up on the debate. I was a bit puzzled by Ann's earlier assertion that having searched the literature she found none to support the new birth visit, and that we need to consider assessments which may be done at any time and should be carried out by a qualified health visitor.

How will we know when it is the right time to assess a family if we don't know them from the new birth at least, and surely we are helping to meet the needs of families by doing a new birth visit? That is usually the time they are at their most vulnerable. Most, in my experience are grateful to see the HV after they have had a new baby, especially a first time mum. Only recently I did a follow up visit to an affluent American mum with a third baby who had several problems. She mentioned that there had been lots of discussions in American magazines about the British system of Midwives and HVs visiting new mums after birth instead of leaving them to get on with it, and how envious they were of this, and wanted it themselves. Perhaps instead of searching the literature for support of the new birth visit we should be asking mums how they feel about it instead?

I also work with a team of nursery nurses who are excellent in lots of ways and who also run some quietCHCs if the HV is not available,and I certainly use them to follow up behaviour problems with toddlers and for teaching mums play skills etc. However, in my experience they just don't usually have the lateral thinking and ability to see further than the immediate presenting problem, that HVs have. For exampe one NN did a visit to talk to the mum about play with her toddler but didn't pick up on the fact that the child had very little speech because that wasn't on her agenda. I'm sure this lack of awareness of the wider agenda could lead to problems being missed at the NBV, and at CHCs however well NN are taught.

Finally, regarding the debate about midwives visiting up to 28 days -haven't we been here before some years ago? Where are all these midwives who are going to visit for 28 days coming from? Certainly where I work, new mums may only get one or two visits from the community midwife in the first 10 days because they are so short staffed, and I have recently had to help 4 breastfeeding mums with latching on and other feeding problems at the NBV, becasue the midwife didn't have time. Only recently too I met a new mum in clinic who was trying to breastfeed but whose baby was given formula in the well known hospital she gave birth in because the midwife told her they were too short staffed to teach her to breastfeed.

June