I'm a health visitor AMA

[CosmicTeacup]

I'm going to regret posting this aren't I?

If you're hiding neglect, you're going to hide it from the HV too. And all those things (which are often either crap or not on in practice) are available via the GP.

@kitchenrollinrollinrollin but some people don't know how to access support so they wouldn't go to the GP and ask for it. And yes, neglect can be hidden from everyone but if you look at some of the famous serious case reviews, Baby P, Keanu Williams etc. Or Lord Laming's report into the death of Victoria Climbie, those children were living in dire conditions that would have been seen by a HV (the reason we now ask to see where the baby sleeps). That would not have been picked up by a GP because they don't see the house. GPs are also not going to attend child protection meetings monthly for children on a plan. GPs aren't going to visit a mother with severe PND, who won't leave the house, every two weeks just to let her rant. The GP is not going to visit the parents that have lost their 6 week old to sudden infant death to see if they're ok, or take a food parcel to the family who are on the bones of their arse and no recourse to public funds, or get a Moses basket filled with baby clothes and toiletries for the young expectant mum whose parents have kicked her out because her pregnancy goes against their religious beliefs. I have done all of these and more and so have my colleagues. You may not see the point in the health visiting service but some people need it.

Do you think HVs should make mutually convenient appointments rather than turn up on step at 9.15 when baby is 12 days old. (When the letter received at 8.50 said 9am - had it said 9.15 I'd have had time to dress and would have been allowed a little dignity). No apology for lateness except an excuse that the ttaffic was bad. Not good if firat apppintment starts late but said everything I needed to know about the attitude and lack of respect.

When asked their role and why they are there do you think hv's should tell the truth. "We are obliged to offer visits to all families with under 5's you are not obliged to accept the service".

Was it wrong that my hv told me I had to attend the clinic?

Was it wrong that my hv told me she was responsible for immunizing my baby. I still wish I'd asked if she had a court order when she said that.

If she thought she was responsible for imm my baby do you think she should have been able to ask questions beyond the government leaflet.

If her view was that mothers who formula fed put themselves first and mothers who breastfed put their babies first do you think that she should have been able to provide clinically excellent advice rather than "I'm not an expert, phone the NCT" 2nd bout of mastitis and what I now know to be thrush of the inner breast as well as bleeding nipples. You may be able to imagine the pain but then again if you are an hv possibly not.

In the above circs was it appropriate to tell me to wrap myself in a blanket and sit by the fire.

When I complained to her manager there was no clarity about the role either but:

Do you think the manager was right to tell me I needed to see a hv because she would be able to tell if I was speaking to my child enough for speech to be developed.

Having agreed that I would have nothing else to do with her staff; one phoned me the following day and when I asked why evidently her manager had thought it would be a good idea.

How do you think that level of care made a new mother feel? A new mother who had a planned and wanted baby, (after 2 mc's), a husband, security and a lovely home. The HV didn't acknowledge that or even say congratulations.

Fortunately the local Community Health Trust upheld the complaint and did explain the HV's role.

I never saw an HV again and no further services were offered at my request. If I felt my baby was ill I took him to a properly qualified doctor or paediatrician. I did not need a HV to tell me to do that.

Oh final HV point if you want to instruct mothers to attend your clinics do you think it appropriate to expect them to sit for hours in the clinic in the same place as the Drs waiting room with a new baby alongside the sick people at the dr's. Do you really think it's right to order a new mummy to attend and not respect her time sufficiently to offer an appointment? Wouldn't we have a clinic, you might find it helpful, here are the details have been better?

Final point. That little baby is now early 20s. He took a first from Oxford. What do you think he'd have achieved if he had seen a HV. The only positive after the speech comment was that I went home and read an 8 week old baby The Iliad and the Odyssey. Nurtured an early love of Classics! Our DD born later is soon off to Cambridge so I really don't think the speech comment was appropriate. It was pretty obvious we were educated parents and pur DC would want for nothing.

If any of you used to work in Wandsworth I hope you are proud of yourselves because that episode upset me for years. It still does when i think of the way an HV and her manager thought they could behave towards a new mummy. Would any HVs on this thread be proud of themselves.

Thank you for reading. End of rant! But it still hurts and took a great deal away from those first few months with a new baby.

ohtheroses I'm sorry you had such a rubbish experience of health visitors. From what you say it does sound as though you had a rough deal and it's sad that experience cast a shadow on early motherhood and shaped your view of the whole profession. I can assure you that things are very different now - at least where I am. Parents are recognised as being the experts in their own children and we are there to offer evidence based support if needed. We're not experts in everything, and don't proclaim to be, but we can help you find the quickest route to the care or service you need. There are undoubtedly families where HVs have little impact, but there are also families where the support of a HV can make a tremendous difference to the health outcomes - especially for the children. I honestly believe that if HVs disappeared overnight the impact on society would be huge.

My health visitor has never asked to see where my baby sleeps or "gone to wash her hands" or she's never snooped she just sits in my living room. I have no problem with them having a look round bit mine never has

Worzels I am afraid I think HVs are a complete and utter waste of time and that those nursing services ought to be redeployed to chronic kr acute healthcare which is seriously understaffed.

In 1996 the then chairwoman of the HV Association said the role of the HV was to teach mothers the three C's. Cooking, Cleaning and Communication. I rest my case in relation to hour "profession"

Do you train as a Health visitor at university or do you do nursing or do you do midwifery?

By directing resources at acute care you are merely firefighting. Research shows that preventative services are much more effective. Teaching cooking and cleaning is certainly not part of my job role. You've obviously made up your mind so I won't waste my energy trying to offer you a more balanced and up to date view of the HV service.

I've written this before on MN but Ohtheroses experience echoes my own experience.

Background - 27 week twins, in NICU/SCBU for 2 months. Guilt, fear, just overall emotional rollercoaster. Devastation at going home without my babies, leaving them on SCBU.

Initial visits (once they were home) from SCBU midwife, regular appointments back at unit / neonatal team - amazing - but then had to take them weekly to local clinic to be weighed and monitored by HVs.

HV was surprised they'd gained more weight than usual 1 week. Told her I'd weaned them (on advice from Neonatal consultant). They were 19 weeks old, general advice at the time was to wean between 4-6 months. In front of a room full of other mums and HVs, she shouted at me saying I would have done irreversible damage to their digestive systems and I was irresponsible. Left in tears - more guilt - went straight to neonatal unit who fortunately agreed to see me as i was in such a state & reassured me that I hadn't damaged them.

A month or so later, another HV phoned me to tell me my daughter's heart procedure was scheduled for the following day. Daughter had been born with a heart issue that could either right itself as she grew or would need surgery. We'd been told a week or so before it was looking good & she didn't need an op. I was therefore gobsmacked, shaking etc. Talked for about 20 mins (with me in tears) when she mentioned my other twin's name (which was wrong). It turned out that she'd phoned the wrong person - another prem twin called the same as my daughter. I was so shocked and upset, I asked her how that could have happened. She said she didn't have time to get the baby's files out or read them, she'd just looked on the system for the number. How can that be in any way acceotable when you're talking to parents about heart surgery?!

That was the straw that broke the camel's back and I made a formal complaint. The PCT agreed to implement better training in respect of prematurity & review their procedures when HVs contact parents.

In light of mixed experiences, what is being done to address inadequacies in hv? It is no point brushing off bad things as one offs because, say, you are a hv yourself and absolutely perfect. Clearly the faults are systemic and few people complain, it is rather intimidating in my experience. You get a threatening letter saying if you refuse they will inform the gp etc. That is intimidating vulnerable potentially. depressed and fragile women. No one ever says it is optional (apart from my midwife - that is what she said: see them once and then you need not have anything to do with them).
So questions to the op: Do you tell mothers your services are optional? Does your training acknowledge how many in your profession are aggressive bullies, and what is done about it?

PS if I want to know about personal experiences I will ask friends and family, so hvs should not volunteer it unless asked, as it comes across as official mantra. Do you disagree?

So what, on behalf of my children, could you have prevented worzels?

Their grommets
DS's asthma from 4 months to 7 - private paed improved that dramatically after struggling for three months with NHS?
Them being sent to the best schools the UK can offer?
Ah perhaps DS's asthma was caused by my failure to breast feed?

@Mightymelon HVs train as midwives or nurses first and then, usually after some experience, do a further course at university and in practice to gain a specialist public health qualification.

@namechangedtoday15 that's terrible and I'm sorry you had such a bad experience. I would always, always have the notes in front of me before calling a parent, not least because I have to document the telephone call. I'm glad you complained.

There are clearly inadequacies across the service and the training for HVs is currently undergoing review, as is nurse training, to address these. As for using personal experience, sometimes it's helpful and sometimes it isn't, I would always make it clear that that's what it was though and it would only be things like "when my dc had colic I found that a warm bath helped them" etc, never contradicting evidence based official advice. Some parents need that because there are families, especially mums, that are terribly isolated and don't have anyone else to ask.

I have never met an awful HV or even one I disliked but the role seems to me really baggy and sort of poorly-thought-through.

Like, DD1 HV was an ex paeds nurse. So great for Qs on weaning, what's this funny rash etc. But her remit also included my mental health and asking me about contraception, apparently

Contraception which she couldn't prescribe and which the MW had already talked to me about - so why ask? Just felt nosy. And she wasn't qualified to deal with MH issues. I know she will have done postgrad training but honestly, speaking as someone who runs a Masters programme, doing a module in maternal mental health just isn't enough to equip you to deal with someone with serious depression, psychosis, suicidal impulses, PTSD or birth trauma. It just isn't and you can do more harm than good, however well-intentioned.

I agree with PP who say it would be better if the role was rebranded as public health nurse whose job was checking for normal development and safeguarding. That's a clear, valuable remit that everyone can understand.

As for a question - OP Mumsnet is possibly the biggest national forum for mums, i.e. your service users. It is in general very supportive of HCP with many threads about those who abuse AandE, waste GP time etc.

So why do you think HV are unusually disliked? Do you think it's snooty ungrateful mums or do you think there might be an issue with the service?

I’m retired now but in all the time I practised, feedback from parents was generally very positive.

Our clinics were extremely well attended to the point that we had to employ extra staff to cope. This suggests to me that our service was wanted and highly regarded.

There will always be instances where things don’t go well, for one reason or another. These are the cases that are put onto an Internet forum, whereas the vast majority of satisfied users don’t post because they haven’t got an axe to grind.

I don't think that's necessarily true Oldagepensioner. If there is ever a thread about the NHS in general, neonatal units, cancer care - all of which I've had 1st hand experience of - I am the first to sing their praises because my family has had bloody amazing care from those professionals.

I think people use clinics /the HV service etc in some cases not because they want to but because they think they have to, or in the case of attending clinics for weight checks/ routine assessments, there is usually nowhere else to go. A busy clinic doesn't (necessarily) mean it's well regarded.

Thank you @CosmisTeacup. Do you inform parents that your service is optional, and why?

I can only go off my own experience, which suggested my team was very well regarded.

@oldagepensioner it is good you loved your job and believe you made a difference. However your view is blinkered. You dismiss those who complain as a minority. Well let me tell you those who complain have been driven to the limit and are really, really upset. A lot would not complain because it is minor or can't be bothered it is over. Would I, sick and tired, trying to recover from birth, sleep deprived have strength (moral and physical) to complain the the hv did not wash hands before handling baby (did it so quick I had no time to open my mouth), was patronising, gave wrong advise, was a bully? Or do I just forget and move on and enjoy my baby, rather than dragging weeks of complaining and getting anxious about it? And when I say thank you and am not rude, it is being polite not positive feedback. No one ever asked for my feedback on the NHS anyway so if my HV said what you did I would call that porkies. Good to know you are so confident perhaps your team did anonymous surveys and had numbers to back up what you say? Sorry OP for the rant

I'm just making my way through this but I just wanted to add that with all three of my children my HV's have been great. I'm not sure how they pick up issues with them being so stretched they may not see you for months but I know that's not down the them but the funding available. It must be a tough job at times especially with the animosity I've heard friends have for them.
Mine were like a support group and cheerleader all in one!

@JohnnyMcGrathSaysFuckOff I have met at least one mum whose first language was not English and had an arranged marriage very young who wasn't even aware that contraception existed! There is a move towards changing the HV title to public health nurse actually and this is being considered, especially as many trusts move across to a 0-19 service.

@JohnnyMcGrathSaysFuckOff and as I've acknowledged, there are inconsistencies in the service which I agree need to be addressed but I think those that get the most benefit from the service are also the least likely to be posting on a parent's forum.

IMO it's for similar reasons that SureStart failed to reach the populations it was supposed to reach - because their approach was patronising and controlling and misogynistic with a nice dose of class contempt thrown in.

Wow! Well I disagree completely with this. I remember in 2006 when I had my first baby. I was in a town where I knew no one other than my husband and his family. My hv ran a group in the school term which I went to after a good few months of being completely isolated and incredibly low. I met a lovely group of women there, many of whom I'm still friends with now. Chatting to us one day about bits and pieces the hv said 'we love that you all come to group but the people who it's aimed at rarely come'
This was way before sure start existed and there weren't many groups at all in my area.
In 2009 when I had my second baby I was still attending other groups with the friends I had made and eventually we did go to several sure start groups.
They were always a real mix of people from different backgrounds and were really well advertised and attended.
Maybe you've been unlucky in your experiences but you can't tar them all with the same brush.