Public+services+-+health+services+-+health+visitors+(20.1.10)


 * Objection to the suspension of the traditional universal health visiting service **

//Sue Hessel - Haringey Federation of Residents’ Associations//
 * Presentation to the Haringey Council Overview and Scrutiny Committee, 20.1.2010**

Firstly I have to express enormous sadness that the health authorities - those entrusted and paid by us to deliver our health services - are now in a situation in which it faces a huge difficulty in recruiting health visitors and is forced into a contingency plan. A combination of:

- Haringey community health cuts, clinic closures and sell offs in 2006, - low health visitor salaries, - low morale, - a deliberate reduction, nationally, in the training of health visitors, - and the impact of the death of Baby P

and you get to where we are today.

This means that for the past eighteen months and in future Haringey health visitors will rely on "socially targeted" visits, to the neglect of parents not deemed most at risk. The whole system now relies on just one health visitor assessment in the first 28 days of a new baby’s life as to whether the baby is at risk ie subject to a Child Protection Plan, or "in Need". If he is assessed as such he will be seen by the Health Visitor again, and there are some very thorough child protection plans before us for this group. My concerns today are for those not deemed at risk for these plans come at a price – and many parents who at one time would have had access to a qualified and experienced health visitor during the early years of their new family will now not do so. This is because the service relies on self referral at baby weighing clinics or by phone where health visitor assistants will be used instead. Like many policies it sounds perfectly logical on paper but the Ctee may wish to examine its implications in real life.
 * A. Suspension of the traditional universal health visiting service** I was actually shocked to learn in the report before us today that in August 2008 - the anniversary of Baby P’s death - a decision was made by Haringey health authorities to actually suspend the traditional universal health visiting service. They said "temporarily" but today we learn that Haringey health authorities can no longer guarantee a universal health visitor service and they have no plans to reinstate it.

Many difficulties reveal themselves as time goes on: Post natal depression, infant disabilities, etc. can emerge throughout babyhood and not always in the first 28 days. Surely it is preferable for every mother in Haringey to have a trusting relationship with a health visitor throughout her child’s infancy until school age.


 * B. I would question the wisdom of not having Health Visitors involved in baby weighing clinics.** Health Visitors are qualified nurses with further specialised training. They are skilled in building up a relationship of trust with young parents, their experience and skills will mean that they are more likely to spot if things are not right, eg a baby with bruising that does not tally with a parents explanation; a baby who is not thriving; a mother who has had difficulty bonding; even the way a mother undresses her baby.

These require a skill of assessment and intuition far more likely to be found in an experienced and qualified health visitor and a baby weighing clinic would be a sensible place to have them. (popular places - 948 visits per month)


 * C. There is a more subtle risk with a health visitor targeting only problematic cases.** And that is that this very selective system runs a risk of stigmatising mothers who have a health visitor as "at risk".

This may make them very reluctant to confide worries that they cannot cope, for fear that they are being scrutinised and could have their baby taken away.

The universal system was much more discreet, it meant that every new mother enjoyed a personal relationship (not simply an initial assessment) with her health visitor – there was no particular worry that she was being scrutinised and she would be more likely therefore to confide her difficulties. Surely we have health visitors to help, not scare, mothers!


 * D. Health Visitor assistants.** We are informed (p.9) that Haringey will employ 10 full time assistants who will have considerable assessment responsiblities. We are not informed as to their qualifications but I am alarmed at the extent of their duties. We learn here that they will be put in charge of the duty desk, follow up appointments for parents who have not kept appointments, and home visits to newly arrived families.

All of these point of contacts can involve "at risk" infants. Baby P’s mother did not maintain appointments and moved around. A struggling mother may finally pluck up courage to phone the service. All may require the speedy intervention of a skilled health visitor and it may be unwise to leave these areas to assistants – how much money are you really saving? Is it worth it?


 * __Questions for scrutiny ctee__:**

There is lots of evidence of very good work here, and I thank the authorities for finally understanding the very important work of health visitors in child protection. However there is a danger here that health visitors are just becoming child protection officers, with overwhelming responsibilities far too reliant on their supervision of less qualified staff. In the process they seem to have lost their former role as family health advisers which is what made them such a trusted institution.


 * 1. Is the Scrutiny Committee happy with proposals to continue to drop the universal health visitor service?**


 * 2. Is it happy to have baby weighing clinics, phone in lines, home visits specifically staffed by unqualified assistants – with health visitors often reliant on the assessments of unqualified staff?**


 * 3. Is the Ctee happy that all new babies are seen only within the first 28 days and not within the first 14 days (as they are in other areas)?**


 * 4. Finally, may I ask for reassurance that all Haringey mothers with a baby with a disability - not because she is at risk but because she will need support - will be regularly visited by a qualified health visitor?**

Sue Hessel Haringey Federation of Residents’ Associations Vulnerable Groups Officer 

20.1.10

Note: Many members of the Scrutiny Committee expressed agreement with the above comments. There will be another meeting scheduled (provisionally March 8th) to consider further evidence and discussion.