Guest guest Posted October 24, 2004 Report Share Posted October 24, 2004 Was interested in your analysis Xena - by the way how are you? After you had originally written and responded, I had put the e.mail aside to comment back as I wanted to say yes I agree about the education whole heartedly and get more evidence about that by the day but also that there was more to it than that. 's suggest that it has been over the last eight years since things have started not to be so right and particularly surface. I am sure the timing is right and I think up until then there had been enough legacy around from the past and an active enough professional organisations to try to address issues and to show the world that they were trying. But it is from 1996 or so that we began to see the idea - health visiting is nursing - and we are all the same and this push at national level to make HVs nurses and that is where I think your confusion comments about the role really fit Xena. Not that we were not confused before - that has always been a debate in health visiting - but I think as health visitors we felt allowed and were enabled to talk about it then but it has felt over recent years that if you raised such issues you would be black listed as perhaps some of us have at times. I know we as health visitors - and that is not just the grey haired ones like me - but all HVs both in practice and not - need to debate how we see the role happening and use the policy that is around to our advantage. We need to be quite selfish at present I think and from the ground debate health visiting, what it is where it is going, how we embrace the role of school nurses as an integral and equal part of health visiting and so on. This I think needs to be national and it should be nationally led and enable just like Patient Choice and of course we need to include the clients views- not someone telling us what we should think. And when we have done this again we need to be enabled - and not forced down a line or told what to do - to make it happen in practice and have proper leadership and all that. As a side point I did a conference on HV about two weeks ago - a week before the CPHVA conference and a third repeat - and got 40 people eager to debate the role and where we were going - it is so necessary. Another thing that has interested me on Senate this week is the reference to mental health. All the research evidence, the stats etc would point to this being something HV and Sn will come across constantly because of its prevalence and we need to have the skills to deal with it and this may be population skills but certainly it will be one to one skills and good interpersonal skills and I ask myself frequently what happened to those in health visiting and indeed in nursing. I could go on but like you will finish with a comment on the role and where it is going - I thibk we are going to have to have two parts to the role and for students I thibk we are going to need to make sure that on qualification they do a bit of both. the children's NSF and I hope the forthcoming public health white paper will help us to do this - certainly this is something I am beginning to suggest to people when I work with them. If we can be clear as Hv about what we need to to do then we can direct this in organisations - so often at present decisions about role and function are being made by others with not understanding of clinical need, history and so on. Take care Margaret serious stuff indeed > > > , wow, well doesn't that highlight all that is so confusing and > wrong about health visiting at present. The fact is, we are so > confused about our own roles, that how can we really defend > complaints about us. Half of us are trying to move forward to > address the wider determinants of health, as long-term solutions, in > partnership with other organisations and agencies, just as we are > meant to be doing, and half are continuing with the close one-to-one > client contact that is so valued for the short term. My own job/role > is completely reflective of this. I am literally half and half. I > have a small (but very intense/high need) caseload to work on as a > health visitor, but half my role and remit is to do exactly as I > said, tackling the long-term issues to improve health and reduce > health inequalities, which, of course, is impossible for a lone > organisation and forces the partnership working. That is a whole > different story. > Meanwhile, our standards in health visiting are so variable. I am > staggered to hear of so many complaints against health visitors. > Where are we going so wrong in people's eyes? In practice, I do > wonder if many colleagues really explain to clients what our role is > and what they can expect from us. that is pretty fundamental, as > disappointment and misunderstanding often results in complaints. I > always ask people when they move into my caseload if they understand > what health visitors do/if anyone explained our role to them before, > and invariably they say no-one explained the role properly and are > relieved to know exactly what we are about. If we are to continue to > work directly with the public on a one-to-one basis, we clearly > cannot afford to lose any of our skills. Yet you say training is > already causing that to happen. Individual clients don't give a toss > about our skills in community development and partnership working. > they only care that we are offering appropriate and effective (and, > more importantly delivered in a way that works for them) > help/information. > > You also raise the issue about breastfeeding. This is such an old > hot potato. We HVs always see that women battle to breast feed to > keep the midwife happy and are relieved when they no longer visit so > they can stop. Yet midwives see us as people that cause the > stoppage. It is a 50/50 problem. Just as many women don't get the > help they need in hospital and the first few days as that don't get > good support from health visitors. It is an ongoing blame culture, > which again, is not what collaborative working is about. I have > always spoken out for us to sell ourselves and the work we do more > effectively. We are very bad at that, yet expect people not only to > to know what we do, but respect it. I think our target group has to > be midwives. How often do we offer to take them out for a day to see > what we do? So this is what happens when they don't understand us. > We are clearly not valued by them as a profession. > > To sum up, this really highlights that we have to really come to a > decision about where we are going as a profession. There are two > schools of thought about public health. I know Senate is very pro > that role and community development etc. etc. but the reality in > practice is that it is clearly not what existing clients want. We > either branch into two different professions or try and bring the two > together more effectively. > Meanwhile, until we sort our own house out, it is going to be > difficult defending our corner. We have to respond though. > Anyway, that is just my first thoughts!! > Take care , I hope you are well and not doing too much!!! > Xena > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 24, 2004 Report Share Posted October 24, 2004 I think that some of the conference speakers were talking about 2 roles as well - the government agenda is still clearly lowering obesity rate4s CHD rates etc and vulnerable children and families are still tacked on to the end of sentences and yet the CNO report and the NSF are clear about their directions. it may be that there will be 2 roles in the future - one focusing on the public health of the whole population and the other focusing on vulnerable children .. not sure .. there seems to be no direction from on high apart from an ex[perctatino that HV's will be there at the centre of it all!! Ann ---- Original Message ----- From: " xenadion01 " <xenadion01@...> < > Sent: Saturday, October 23, 2004 10:36 PM Subject: serious stuff indeed > > > , wow, well doesn't that highlight all that is so confusing and > wrong about health visiting at present. The fact is, we are so > confused about our own roles, that how can we really defend > complaints about us. Half of us are trying to move forward to > address the wider determinants of health, as long-term solutions, in > partnership with other organisations and agencies, just as we are > meant to be doing, and half are continuing with the close one-to-one > client contact that is so valued for the short term. My own job/role > is completely reflective of this. I am literally half and half. I > have a small (but very intense/high need) caseload to work on as a > health visitor, but half my role and remit is to do exactly as I > said, tackling the long-term issues to improve health and reduce > health inequalities, which, of course, is impossible for a lone > organisation and forces the partnership working. That is a whole > different story. > Meanwhile, our standards in health visiting are so variable. I am > staggered to hear of so many complaints against health visitors. > Where are we going so wrong in people's eyes? In practice, I do > wonder if many colleagues really explain to clients what our role is > and what they can expect from us. that is pretty fundamental, as > disappointment and misunderstanding often results in complaints. I > always ask people when they move into my caseload if they understand > what health visitors do/if anyone explained our role to them before, > and invariably they say no-one explained the role properly and are > relieved to know exactly what we are about. If we are to continue to > work directly with the public on a one-to-one basis, we clearly > cannot afford to lose any of our skills. Yet you say training is > already causing that to happen. Individual clients don't give a toss > about our skills in community development and partnership working. > they only care that we are offering appropriate and effective (and, > more importantly delivered in a way that works for them) > help/information. > > You also raise the issue about breastfeeding. This is such an old > hot potato. We HVs always see that women battle to breast feed to > keep the midwife happy and are relieved when they no longer visit so > they can stop. Yet midwives see us as people that cause the > stoppage. It is a 50/50 problem. Just as many women don't get the > help they need in hospital and the first few days as that don't get > good support from health visitors. It is an ongoing blame culture, > which again, is not what collaborative working is about. I have > always spoken out for us to sell ourselves and the work we do more > effectively. We are very bad at that, yet expect people not only to > to know what we do, but respect it. I think our target group has to > be midwives. How often do we offer to take them out for a day to see > what we do? So this is what happens when they don't understand us. > We are clearly not valued by them as a profession. > > To sum up, this really highlights that we have to really come to a > decision about where we are going as a profession. There are two > schools of thought about public health. I know Senate is very pro > that role and community development etc. etc. but the reality in > practice is that it is clearly not what existing clients want. We > either branch into two different professions or try and bring the two > together more effectively. > Meanwhile, until we sort our own house out, it is going to be > difficult defending our corner. We have to respond though. > Anyway, that is just my first thoughts!! > Take care , I hope you are well and not doing too much!!! > Xena > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 25, 2004 Report Share Posted October 25, 2004 Margaret, hi, yes doing well thanks, suitably recovered!! As always you bring an important perspective. I think it would be good to have an away day to debate the future, but I can imagine there are some very animated discussions ahead and I fear there would never be an overall consensus of opinion enough to give clear direction. I would welcome the chance of debate, like many others, as you pointed out. The increasing mental health aspect is just a part of the dilemma of when you are coming into contact with individuals it is hard just to signpost them on when you know their need is immediate and you have the ability to help them work through some of the issues. Yet if the public health role (or rather the population approach, which demands some all singing all dancing local partnership based initiative!!) is pressing, you have to put individuals on 'hold'to attend all the meetings and community lunches and everything else that goes with 'partnership working'. Hmmm. It is back to the looking upstream stuff. We have to take time out to deal with the thing that is pushing people into the river, but how many people have to 'drown' whilst we are trying to deal with it, and even if we can identify it, can we actually deal with it effectively. Reading Wanless, I was left even more in despair about all the public health side of things we are meant to be involved in, we have such little evidence that what we do makes a difference when we are working with a more population focus. Do you know the great thing about Senate chaps, is that we can say these things without being 'struck off' or 'blacklisted'. It is a precious resource. > Was interested in your analysis Xena - by the way how are you? > > After you had originally written and responded, I had put the e.mail > aside to comment back as I wanted to say yes I agree about the education > whole heartedly and get more evidence about that by the day but also that > there was more to it than that. > > 's suggest that it has been over the last eight years since things have > started not to be so right and particularly surface. I am sure the timing > is right and I think up until then there had been enough legacy around from > the past and an active enough professional organisations to try to address > issues and to show the world that they were trying. But it is from 1996 or > so that we began to see the idea - health visiting is nursing - and we are > all the same and this push at national level to make HVs nurses and that is > where I think your confusion comments about the role really fit Xena. Not > that we were not confused before - that has always been a debate in health > visiting - but I think as health visitors we felt allowed and were enabled > to talk about it then but it has felt over recent years that if you raised > such issues you would be black listed as perhaps some of us have at times. > > I know we as health visitors - and that is not just the grey haired ones > like me - but all HVs both in practice and not - need to debate how we see > the role happening and use the policy that is around to our advantage. We > need to be quite selfish at present I think and from the ground debate > health visiting, what it is where it is going, how we embrace the role of > school nurses as an integral and equal part of health visiting and so on. > This I think needs to be national and it should be nationally led and enable > just like Patient Choice and of course we need to include the clients views- > not someone telling us what we should think. And when we have done this > again we need to be enabled - and not forced down a line or told what to > do - to make it happen in practice and have proper leadership and all that. > As a side point I did a conference on HV about two weeks ago - a week before > the CPHVA conference and a third repeat - and got 40 people eager to debate > the role and where we were going - it is so necessary. > > Another thing that has interested me on Senate this week is the reference to > mental health. All the research evidence, the stats etc would point to this > being something HV and Sn will come across constantly because of its > prevalence and we need to have the skills to deal with it and this may be > population skills but certainly it will be one to one skills and good > interpersonal skills and I ask myself frequently what happened to those in > health visiting and indeed in nursing. > > I could go on but like you will finish with a comment on the role and where > it is going - I thibk we are going to have to have two parts to the role and > for students I thibk we are going to need to make sure that on qualification > they do a bit of both. the children's NSF and I hope the forthcoming public > health white paper will help us to do this - certainly this is something I > am beginning to suggest to people when I work with them. If we can be > clear as Hv about what we need to to do then we can direct this in > organisations - so often at present decisions about role and function are > being made by others with not understanding of clinical need, history and so > on. > > Take care > > Margaret > > > serious stuff indeed > > > > > > > > , wow, well doesn't that highlight all that is so confusing and > > wrong about health visiting at present. The fact is, we are so > > confused about our own roles, that how can we really defend > > complaints about us. Half of us are trying to move forward to > > address the wider determinants of health, as long-term solutions, in > > partnership with other organisations and agencies, just as we are > > meant to be doing, and half are continuing with the close one-to- one > > client contact that is so valued for the short term. My own job/role > > is completely reflective of this. I am literally half and half. I > > have a small (but very intense/high need) caseload to work on as a > > health visitor, but half my role and remit is to do exactly as I > > said, tackling the long-term issues to improve health and reduce > > health inequalities, which, of course, is impossible for a lone > > organisation and forces the partnership working. That is a whole > > different story. > > Meanwhile, our standards in health visiting are so variable. I am > > staggered to hear of so many complaints against health visitors. > > Where are we going so wrong in people's eyes? In practice, I do > > wonder if many colleagues really explain to clients what our role is > > and what they can expect from us. that is pretty fundamental, as > > disappointment and misunderstanding often results in complaints. I > > always ask people when they move into my caseload if they understand > > what health visitors do/if anyone explained our role to them before, > > and invariably they say no-one explained the role properly and are > > relieved to know exactly what we are about. If we are to continue to > > work directly with the public on a one-to-one basis, we clearly > > cannot afford to lose any of our skills. Yet you say training is > > already causing that to happen. Individual clients don't give a toss > > about our skills in community development and partnership working. > > they only care that we are offering appropriate and effective (and, > > more importantly delivered in a way that works for them) > > help/information. > > > > You also raise the issue about breastfeeding. This is such an old > > hot potato. We HVs always see that women battle to breast feed to > > keep the midwife happy and are relieved when they no longer visit so > > they can stop. Yet midwives see us as people that cause the > > stoppage. It is a 50/50 problem. Just as many women don't get the > > help they need in hospital and the first few days as that don't get > > good support from health visitors. It is an ongoing blame culture, > > which again, is not what collaborative working is about. I have > > always spoken out for us to sell ourselves and the work we do more > > effectively. We are very bad at that, yet expect people not only to > > to know what we do, but respect it. I think our target group has to > > be midwives. How often do we offer to take them out for a day to see > > what we do? So this is what happens when they don't understand us. > > We are clearly not valued by them as a profession. > > > > To sum up, this really highlights that we have to really come to a > > decision about where we are going as a profession. There are two > > schools of thought about public health. I know Senate is very pro > > that role and community development etc. etc. but the reality in > > practice is that it is clearly not what existing clients want. We > > either branch into two different professions or try and bring the two > > together more effectively. > > Meanwhile, until we sort our own house out, it is going to be > > difficult defending our corner. We have to respond though. > > Anyway, that is just my first thoughts!! > > Take care , I hope you are well and not doing too much!!! > > Xena > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 26, 2004 Report Share Posted October 26, 2004 Xena, thank you for your analysis of the situation and continued enthusiasm; you are right it is great to discuss and debate the issues. I am sure, thinking back to your last email, that you are right; somehow we have to get the balance of both individual and community work. I am interested in your perspective below, because often the time-pressure dilemma is presented in the opposite way: that clients have immediate needs that cannot be left, so we cannot make time to attend partnership meetings etc. And all that contact counting did not help, either, encouraging the view that one-to-one is more important (instead of equally important) than community based work. I remain convinced that community outreach work of any kind is easier once you know the local mums through home visiting, anyway, but don't have any evidence (other than anecdote) of that. I am (lucky me) shortly going to New Zealand to speak at a conference about needs assessment, and their Plunket Association tell me they are 'grappling with a population funding model based deprivaton,' but coming up against the same difficulties: How to continue a universal service for all, but provide extra for those who need extra. They offer a universal component of 6 contacts in the first two years, with an additional 4 contacts for first time parents as a baseline, and extra as required. At first glance, that seems more generous than Hall4 or the baseline in the new NSF, but I think that may include contacts that we would regard as within the midwifery domain. I shall be interested to hear what, if anything, they do about community outreach. best wishes xenadion01 wrote: Margaret, hi, yes doing well thanks, suitably recovered!! As always you bring an important perspective. I think it would be good to have an away day to debate the future, but I can imagine there are some very animated discussions ahead and I fear there would never be an overall consensus of opinion enough to give clear direction. I would welcome the chance of debate, like many others, as you pointed out. The increasing mental health aspect is just a part of the dilemma of when you are coming into contact with individuals it is hard just to signpost them on when you know their need is immediate and you have the ability to help them work through some of the issues. Yet if the public health role (or rather the population approach, which demands some all singing all dancing local partnership based initiative!!) is pressing, you have to put individuals on 'hold'to attend all the meetings and community lunches and everything else that goes with 'partnership working'. Hmmm. It is back to the looking upstream stuff. We have to take time out to deal with the thing that is pushing people into the river, but how many people have to 'drown' whilst we are trying to deal with it, and even if we can identify it, can we actually deal with it effectively. Reading Wanless, I was left even more in despair about all the public health side of things we are meant to be involved in, we have such little evidence that what we do makes a difference when we are working with a more population focus. Do you know the great thing about Senate chaps, is that we can say these things without being 'struck off' or 'blacklisted'. It is a precious resource. Was interested in your analysis Xena - by the way how are you? After you had originally written and responded, I had put the e.mail aside to comment back as I wanted to say yes I agree about the education whole heartedly and get more evidence about that by the day but also that there was more to it than that. 's suggest that it has been over the last eight years since things have started not to be so right and particularly surface. I am sure the timing is right and I think up until then there had been enough legacy around from the past and an active enough professional organisations to try to address issues and to show the world that they were trying. But it is from 1996 or so that we began to see the idea - health visiting is nursing - and we are all the same and this push at national level to make HVs nurses and that is where I think your confusion comments about the role really fit Xena. Not that we were not confused before - that has always been a debate in health visiting - but I think as health visitors we felt allowed and were enabled to talk about it then but it has felt over recent years that if you raised such issues you would be black listed as perhaps some of us have at times. I know we as health visitors - and that is not just the grey haired ones like me - but all HVs both in practice and not - need to debate how we see the role happening and use the policy that is around to our advantage. We need to be quite selfish at present I think and from the ground debate health visiting, what it is where it is going, how we embrace the role of school nurses as an integral and equal part of health visiting and so on. This I think needs to be national and it should be nationally led and enable just like Patient Choice and of course we need to include the clients views- not someone telling us what we should think. And when we have done this again we need to be enabled - and not forced down a line or told what to do - to make it happen in practice and have proper leadership and all that. As a side point I did a conference on HV about two weeks ago - a week before the CPHVA conference and a third repeat - and got 40 people eager to debate the role and where we were going - it is so necessary. Another thing that has interested me on Senate this week is the reference to mental health. All the research evidence, the stats etc would point to this being something HV and Sn will come across constantly because of its prevalence and we need to have the skills to deal with it and this may be population skills but certainly it will be one to one skills and good interpersonal skills and I ask myself frequently what happened to those in health visiting and indeed in nursing. I could go on but like you will finish with a comment on the role and where it is going - I thibk we are going to have to have two parts to the role and for students I thibk we are going to need to make sure that on qualification they do a bit of both. the children's NSF and I hope the forthcoming public health white paper will help us to do this - certainly this is something I am beginning to suggest to people when I work with them. If we can be clear as Hv about what we need to to do then we can direct this in organisations - so often at present decisions about role and function are being made by others with not understanding of clinical need, history and so on. Take care Margaret serious stuff indeed , wow, well doesn't that highlight all that is so confusing and wrong about health visiting at present. The fact is, we are so confused about our own roles, that how can we really defend complaints about us. Half of us are trying to move forward to address the wider determinants of health, as long-term solutions, in partnership with other organisations and agencies, just as we are meant to be doing, and half are continuing with the close one-to- one client contact that is so valued for the short term. My own job/role is completely reflective of this. I am literally half and half. I have a small (but very intense/high need) caseload to work on as a health visitor, but half my role and remit is to do exactly as I said, tackling the long-term issues to improve health and reduce health inequalities, which, of course, is impossible for a lone organisation and forces the partnership working. That is a whole different story. Meanwhile, our standards in health visiting are so variable. I am staggered to hear of so many complaints against health visitors. Where are we going so wrong in people's eyes? In practice, I do wonder if many colleagues really explain to clients what our role is and what they can expect from us. that is pretty fundamental, as disappointment and misunderstanding often results in complaints. I always ask people when they move into my caseload if they understand what health visitors do/if anyone explained our role to them before, and invariably they say no-one explained the role properly and are relieved to know exactly what we are about. If we are to continue to work directly with the public on a one-to-one basis, we clearly cannot afford to lose any of our skills. Yet you say training is already causing that to happen. Individual clients don't give a toss about our skills in community development and partnership working. they only care that we are offering appropriate and effective (and, more importantly delivered in a way that works for them) help/information. You also raise the issue about breastfeeding. This is such an old hot potato. We HVs always see that women battle to breast feed to keep the midwife happy and are relieved when they no longer visit so they can stop. Yet midwives see us as people that cause the stoppage. It is a 50/50 problem. Just as many women don't get the help they need in hospital and the first few days as that don't get good support from health visitors. It is an ongoing blame culture, which again, is not what collaborative working is about. I have always spoken out for us to sell ourselves and the work we do more effectively. We are very bad at that, yet expect people not only to to know what we do, but respect it. I think our target group has to be midwives. How often do we offer to take them out for a day to see what we do? So this is what happens when they don't understand us. We are clearly not valued by them as a profession. To sum up, this really highlights that we have to really come to a decision about where we are going as a profession. There are two schools of thought about public health. I know Senate is very pro that role and community development etc. etc. but the reality in practice is that it is clearly not what existing clients want. We either branch into two different professions or try and bring the two together more effectively. Meanwhile, until we sort our own house out, it is going to be difficult defending our corner. We have to respond though. Anyway, that is just my first thoughts!! Take care , I hope you are well and not doing too much!!! Xena Quote Link to comment Share on other sites More sharing options...
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