So what is the point of Health Visitors?

[wonderstuff]

I've seen 3 so far, they all seem very nice, but really not very useful.

Today lovely lady came by, did PND questionnaire, weighed my baby. Talked about weaning - advised that some babies (especially boys) are ready for weaning at 4 months, to be aware of him taking interest in us eating couldn't give any advise about BLW as no reseach has been done and she doesn't want to get sued - fair enough, but seemed strange that on the weaning age she was willing to contradict research evidence. She also warned of 'missing weaning window at 6 months' I didn't ask what would happen - will I end up bfeeding forever, Little Britain style? Told me breastfeeding was tiring (there was me thinking it was the lack of sleep that was knackering but presumbably if I bottle fed I'd have much more energy?) She stayed for half an hour.

Really what is the point - could money be better spend on Midwifery or Social care?

They actually DO exist???...... I never saw 1 at all, received a letter very early on explaining there was a shortage & that as I wasn't considered to be in any high risk group that if I wanted any advice, weighing etc I was to go to the local childrens center & I was SENT a PND questionaire

Though, I've got to be honest, I was quite glad, as the ones I met at the center, though lovely & friendly, were pretty rubbish & we disagreed on a lot of stuff, that I turned out to be right about, such as DDs skin problems NOT been excema at all, & they could offer no advice on my own health problems, some of which, later turned out to be labour related, could of saved years of grief if someone had bloody listened

Its like everything in life .. it all comes down to your own experience doesnt it

My first ds was stillborn, my ds2 was born almost exactly a year later

The day my hv came out with pnd questionnaire it would have been my ds1 first birthday

As you can imagine I told her in quite strong terms that I didnt feel like filling in her stupid form.. she said ok I'll come back but she never did!

Now I know I was partly to blame but surely someone with half a brain would have thought .. right that woman has a lot to cope with so she might need extra help.. I'll pop back or ask a colleague to visit

gaelicsheep mentioned cringe worthy contraceptive chats - one HV tried that with me distracted with upset toddler and baby on my lap, my mother sat next to me, a hysterical unknown mother with her distressed baby, who was upsetting my DC with its screaming, and her un-introduced colleague other side of me and one row behind an entire waiting room full of people listening avidly and heckling.

Only time in my life - I was then a grown woman of 30- that I've been glad my very prudish mother was next to me when someone tried to talk/grill me about my sex life. Her displeasure was made know to HV and the 'audience' - while I sat in stunned embarrassed silence.

As she?d been to the house twice ? both times arriving unannounced on my door step - I?ve no idea why she thought that was the best setting for such a conversation.

Unfortunately the only way I know there are hard working indispensable HV doing a lot of good out there because of threads like these ? all the ones I?ve met have been unhelpful and ill informed or odd -luck of the draw I guess.

Thought I would rejoin thread as still going on about what a waste HVs are.
Told you about my day yesterday,at refuge and seeing new babies,felt quite a positive day.
Well today was horrible. Was due to write court report this morning but was notified by GP that one of my families had a baby die in the night to cot death aged 17 weeks. I know the family well,phoned and mum asked me to visit. Left the report and went round for 2 hours with very upset family.Talked,listened,talked listened more. Will visit again and will go to funeral at mothers request. So sad left feeling drained.
Then this afternoon baby clinic. Busy,lots of intense enquiries about weaning,breastfeeding etc plus mum with PND crying who I tried to bring in early but was met with complaints from other mothers.
Still havent done report. Tomorrow if this thread is still rolling will tell you about child protection conference with addict mother who has neglected 2 yr old and tells me Im f*ing whore.
Am I worth £34k ? Trained nurse,trained childrens nurse,HV,degree child psychology,UNICEF breastfeeding counsellor.and years of experience. This is top of my salary scale unless I go into management.
Going to get a G&T feel shit.

With all this health visitor bashing, I feel tempted to write a letter to my health visitor and tell her how lovely she is.

"mechanism to ensure that they are not suffering from a personality disorder or other mental illness themselves?"

Why? With my son had a health visitor who openly admitted to being biopolar. She is on medication for life and its no different to someone with diabetes. Infact this lady was very good.

Can I ask jollypirate or anyone else in the know what the situation is re training for HVs?

I am a teacher and earn less than 34k and reckon I work pretty damn hard for my salary. Part of our contract is that we take part in continuing professional developement, through attending courses, reading literature etc.

I cannot see why HVs are NOT up to date on things like BLW, Bfing etc? The girls at my local BFN group said that they invite HVs to their peer supporter training and they wont come! Do they not have a contractual obligation to keep up to date?

Following my run-in with my disastrous HV I spent lots of time with the BFN group, read books and spent time on MN/Kellymom and now feel fairly well informed re Bfing - why can't they do that?

I actually thought they earned much less than £34k so thought it might not be realistic to ask them to attend eg twilight courses, weekend training etc like I do. But for that amount why the bloody hell not?!!

HV's are not a waste of time. I work in child protection and regularly request health visitor reports. They have the best insight and experience in child health and development and are an invaluable resrouce to many women who cant cope and are poor and isolated. Just becasue you have a nice life and a nice house to bring your children up in, doesn't mean everyone does.

I have to go to mandatory training updates each year which include breastfeeding updates,child protection and child health. Plus specialist areas like domestic violence,conflict resolution and any training days put on by the child development unit at the local hospital.We have professional yearly development plans so dont know why people are still getting wrong advise.

Caz10 They start at more like $25K and that's after the years of training to be a nurse or midwife and then a couple of years + as a nurse or midwife before you're likely to be accepted on to an HV course. HVs aren't newly qualified people at the bottom of their profession. And their workload is, sadly, more similar to a social worker's than to a lactation consultant's.

Personally, after reading this thread, I think that's the "problem" with the HV service really. It's promoted as a universal support service for mothers in general, but it seems to be focused mainly on child protection. Stretched too thin and with a remit that does not really match its broad user base.

Tbh Caz10 the eucation (such as it was) uring my HV training for breastfeeding was a paltry 2 hours - it's shite, the peopke I trained with would have learned more from an experienced breastfeeding mother than they did in that lecture. As an ex-midwife and an ex-breastfeeder (albeit I struggled) I feel fairly confident in the advice I give - the same is not true of all my colleagues. It seems that HVs are jack of all trades and truly master of none. I have had ructions this week for criticising the weaning display in the doctors waiting room which gave useful tips for weaning "start with purees" doncha know. I could scream sometimes. My 7 yr old was weaned (BLW style) when he grabbed a roast pot off my plate at five months and crammed it in his mouth (most went on the floor). I know about BLW and a recent advisory mail said we should be advising it and went into detail (correct I might add) about the advice we should give with regard to this. So you can see my frustrations and in return I can understand yours and all other MNers (or any woman) who has recieved shit advice.

On the other hand my caseload (the active part of it) consists entirely of child protection, postnatal depression and other emotional health problems (but mainly child protection) as such I update myself on those issues when I have protected update days as they form the bulk of my work. This does not mean I cannot read and laugh at the C&G updates or take more seriously the other stuff. Just that they are not currently forming my workload and so I get other help in for women and respect the fact that a breastfeeding supporter now knows far more than I do about keeping a breastfeeding mother going. It's not ideal but just how it is at the moment.

And as I said earlier - there are those who are just plain lazy and don't want to do anything beyond the standard agreed updates.
The same HVs who laugh at me running round like the proverbial headless chicken and criticize my messy desk. Thank God the one I have in mind is retiring next month and taking her perfectly groomed nails with her.

Jaffa sounds like you totally deserve your g&t. I guess a lot of us only get 1 experience of hvs so thats the one that we will trot out at every opportunity

While you are having your g&t give yourself a pat on the back for being much better than some of the maddies mentioned on this thread

Jaffa may be a shit day for you but you still made a difference to the poor mother who lost her child , pnd lady & the child of the addict

Again and again the good HV's are bogged down in child protection and social work related issues. Why is the service offered to all mothers regardless on a continuing basis. I'm quite sure I would have been a complete waste of Jaffa Cake's and Jolly Pirate's time. Nevertheless: wanted baby, married parents in their mid thirties, lovely home, very very privileged children (sorry - don't mean to brag). Arsy, class ridden, uncaring, political comments from HV.

I was told at NHS ante-natal classes that the HV was invaluable and would pick up where the fantastic community midwives left off - the HV wasn't invaluable the comm mids weren't fantastic. Even 15 years ago the comm mids provided a dreadful service followed by a worse one from the HV's. Why isn't the system more honest - I simply don't understand and I don't think I'm thick. I did not need an HV and had I been told of limitations in post natal period during the ante natal period, I would have made alternative arrangements but was not given the opportunity.

DD = private birth, refused HV service in writing as a result of previous formal complaint. I was more than capable of purchasing support and in the meantime I had read so many books that I successfully fed dd. Poor community midwifery and HV pushed me into six months of bf related pnd in spite of all advantages. Had the system been more honest I could have arranged alternatives and the hv's would not have had to visit me leaving them with more time to devote to those who really needed them.

On the point of 34k why on earth aren't more hv's in formal capability processes leading to dismissal if they aren't capable of the fulfilling the role?

In our area at 8wks post natal HVs do a family needs health assessment which is based around the same assessment that social workers do with families.This is clearly seen by the parent on the form as looking at the needs of the child which could be adversely affected by parenting issues,ie DV,drugs,alcohol PND.Living conditions ie poor housing like B&B or hostels or at risk of eviction. The 3rd part is the development of the child ie health complications or delay.
By going through this which takes about 20mins you can then target those in need and also be honest with parents about where the service goes. If a family have no extra needs they are offered the core HV service which is phone contact advise and access to clinics. This is then being straight with all families that not everyone needs or wants health visiting.

But Jaffacake surely some of that assessment is done before the birth by comm. midwives and GP's. Why can't the info they glean, ie, whether on benefits, occupation, living circumstances, abusive relationships, addictions, and I still recall "do you want IT"!!!!!!!! etc., be passed directly to the HV's avoiding the need for unnecessary blanket visits.

Caz10, the situation re HV training is this: To become a HV you have to have trained as a nurse or midwife (3 years training) and then completed at least 2 years in practice before then completing in a degree course as a specialist public health nurse (the new term for health visitors. The starting salary is around 26k rising to a maximum of 34k for those with 10 years exeperience.

In my case I did a 4 year degree in paediatric nursing followed by a specialist diploma in paediatric oncology nursing and then a degree in Public health to gain my health visiting qualification, in addition to 10 years experience as a paediatric nurse and ward sister.

Some is known by MWs but noone else will have visited the home so reality is often not uncovered until after the birth. Drug addicts are usually known and I will visit antenatally to try and get some idea of risks. GPs may have some history but still have not seen the home environment.
I guess as HV numbers dwindle,not many being trained inspite of what the govt say and lots ready to retire, then we will really see what does happen when noone fully assesses a childs living environment.

Sorry for all the spelling mistakes, been a long day...

I agree that HV are lovely and every new mother should have one. From my own personal experience as a young mum was that the service was inept at a time when I needed it most. My question (re: first born) 1986 to the HV was "how long can I express milk and still keep my supply?" This was to give time for the sore bits to heal etc. Her answer - "whatever you think" It was so uncommital, and subsequent to that re: potty trainning, it was the same answer. To sum up, they were unwilling to give any direct advice and what I desperately wanted and needed at the time was some confident advice to follow. We survived but the HV was just a visitor imo. Interestingly I was told at the time that the service can be called upon for all ages in the family, not just infants, does anyone know if that still applies?

Jaffacake2 What you seem to be saying is that a primary purpose of Health Visiting, effectively, is to check whether parents are fit to parent without government interference. And the universal home visits are a way to make that possible.

I find that quite a scary policy for a democracy.

SuchProspects - I think you will find that the history of the HV begins long before the NHS and that yes, the health and welbeing of children for the "Health of the Nation" was of great interest to the government. They had the prospect of WW1 and realised how poorly prepared in terms of health care we were.

such prospects- I wouldnt put it like that. I would see it as protecting the most vulnerable in our society thats what a democracy should thrive to do.
If you look at statistics we have 3children die a week either from abuse or neglect from carers,millions of children in poverty and the worse child mental health in Europe.
Its a service looking at health needs of children. Years ago this would have been 1 HV to 150 families now its more like 1 HV to 600 families. Thats why although a universal service it concentrates on the most vulnerable families.

jaffacake2 lol. No. Nobody in their right minds would put it like that if they wanted the service to survive. But it seems to be (part of) what you're doing.

I could see health professionals (and the public) thinking about it and deciding it's problematic but on balance it's worth the cost. But I would expect the ethical issues to be flashing brightly the whole time and subject to significant and ongoing debate. But it seems to have been brought in in an very paternalistic manner and to be subject to little if any debate. I find that to be worrying.

The number of health visitors isn't really the issue on this point - since even if you could provide 80 hours of one-on-one time per mum and a daily cleaning service as a bonus, doing so in order to surreptitiously gain access to the house to see if they "pass" is still ethically dodgy.

That should be "if they wanted the service to survive in that form". I do want Health Visiting to survive - I do think there's a lot of valuable work done by HVs, but I'd like to see changes.

If the main purpose of HVs is child protection, how can they justify completely ignoring a child that's newly moved into the area (as happened to us, see below). And how can they just leave babies for months on end without being seen? Problems could develop (PND for example) and nobody might know about it until it was too late?