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?

I have given birth to two children in this country and I still find the HV system very very odd. I was never quite sure if it was a service for me/us or more the nanny state making sure parents are doing their job. The HVs I met where all nice people but I never got my head around the concept that, like it or not, someone just materialises on my doorstep to inquire after my baby. It is just a wee bit patronising. In many other European countries (who also have publicly financed healthcare, I might add) you would take up your children's health concerns with "your" usually hand-picked paediatrician. Advice on breastfeeding etc. in the first couple of weeks would come from your own midwife. All in all, much better trained HCPs and a lot more of them.

Schroedinger- A HV is part of the primary health care team who works with GPs and MWs. She is commissioned by the NHS as a trained nurse to visit every baby born in UK. This isnt to "inquire" after the baby but will do an assessment of the familys health needs.Then will follow up on families who have extra needs which will affect the child's health ie housing,parenting or developmental needs.

Why would you see that as patronising?

In your country are the assessments by paediatricians private paid or state funded?

What happens to vulnerable families ? Are they catered for ?

Jaffa (and Ghostly) I think you sound like lovely ladies and I wish either of you had been my HV. I might not have ended up in the state I did. But that doesn't mean others should have received inadequate care and it doesn't mean that the system should not be delivered more honestly than it is at present. I would wholeheartedly support a proper review to ensure quality standards and that care was properly directed and that every new mother in the UK was given a clear definition of what a HV was expected to provide and when. Is that really such a problem?

No what I dont understand is why so many people still hold an unrealistic opinion of what HVs are commissioned to do. That is the fault of individual HVs who are not open with parents about the service.

When I see my families at 8wks for a family needs health assessment I explain what the core HV service is available to them ,contact telephone advice,open clinics and a home visit if they feel there is a bigger problem they need to talk through.
Then I explain which families receive the targetted service out of the 580 families I cover.
I think thats why I get upset by these sorts of threads,its frustrating to read the annoyance of so many people when I know what a crucial job it is to vulnerable children.

The health visitor system has worked well for many years. It has helped many families including my own.

I think that a review is needed in what health visitors should do and how their services should be delivered. For example many families have two working parents and its hard to access clinic.

Should babies be weighed so much. Many mothers get their babies weighed excessively and this leads to anxiety about weight gain.

I would like health visitors to mix with their communites more. I am sure other people would have ideas how this might be done.

This is happening with the breastfeeding cafe and there are groups for young parents and special needs run by health visitors. I would like to see more of these drop in groups. Prehaps covering areas like potty training, sleep, developmental worries. Support groups are a good way of helping a large group of mothers. The mothers also support themselves and make friends.

For example a breastfeeding cafe with 10 mothers and one health visitor and one nursery nurse is a good use of time. If the health visitor sees the same mothers each week then she spot depression.

When a health visitor makes a home visit I think that the time needs to be more focussed. For example a listening visit where a health visitor talks incessantly about her family is a bit of a waste of time. Sometimes too much parenting advice can reduce the confidence of a mother. It can lead to learned helplessness.

A good health visitor will empower a mother and boost her self esteem. However even the best health visitor is not a mind reader. She needs to know what you want from her.

I started off wondering what the point of my hv for ds2 was and thinknig she was pushy but she has been lovely. I've got parkinsons and she got me appointments with a Parkinsons nurse, physio and OT without making me feel i wasn't coping, I was coping but she made it much easier for me to enjoy DSrather than just hang on in there. She supported me while i battled to keep up bf' ing until even i accepted that it was best for me and ds to start taking the meds. Marvellous woman.

Couldn't HVs make it clear that the service isn't compulsory, if indeed it isn't? If you can say 'no thanks' without being put under suspicion, it would help to know that.

soxhound- why would you not want a visit following the midwives discharge? Cant really see why people would not want the service especially as it is fairly minmal unless there are problems.
Parents can then chose whether they want to come to clinic or not. Alot of my parents only use Hv service for a few months but always know that I will phone back if they have a query later on.

I can't really comment on my first HV because I was lucky if I saw here more than twice but the other ladies on outr HV team were really good - apart from the daft comment made on your baby looks orange you're giving her too much carrot!

My second HV is absolutely fantastic and was soooo supportive after birth of DD2. She has been brilliant and I've just foudn out she has left the team and wholst the others are still really good, I am sad that she has moved on.

Just like other health professionals they are totally overstretched as a service and I'm sure that they would like to have more contact with families than they have but just simply don't have the time - just like alot of other professionals in their work too.

Before DD arrived I thought that I wouldn't want a HV to invade my house, I would be fine and not need anything from the HV. Things didn't turn out the way I thought they would and I haven't been mobile enough to get DD to any clinics. The HV has been twice so far and will be back again. She is lovely and has the time that a GP might not to answer all of my questions. She also encouages me to look after myself and see my GP if necessary.

I also agree with reallytired in terms of focussing the service and the breastfeeding cafe service.

Care needs to be taken in terms of focussing the service however as 2nd time round I was deemed to be a cpompetent mother and was told you'll be fine, you know what you're doing now its number 2. what they didn't bank on was my little bundle of trouble who made everything trickier than it ought to have been and knocked my confidence soo much that I felt like I'd never had a baby before in my life (depsite the 4 yr old evidence running round in front of me). My HV made me feel that i could cope and supported me magnificently :-)

So is it not compulsory?

No its not compulsory- just say you dont want the service. Then get on with it.

jaffacake2,
If you were in charge what changes would you make to the health visiting service. How would you make it promote good public health rather than being the baby police?

How would you improve things? How should the service develop in the 21st century? How shoud it be modenised? Especially as the pressures faced by parents are different to our granparents.

Even the nicest of mothers can be difficult. (Especially when mentally ill) It is a skilled job and is more than weighing a cute baby.

I went to see my HV today and almost lost the will to live. Apparently my DC2 is fat, short and has a small head. I'm sure that's not the case but that seemed to be the jist of it. She told me to cut out his biscuits (he doesn't eat them) and give him a balanced diet (I do). Then she told me he has dry skin and I had to see the GP! Hilarious waste of time.

None of the HVs on this thread have answered my question about whether HV records are routinely transferred between areas along with medical records - if not, why not? Nor my questions about how it is possible to identify vulnerable children by waiting for their parents to contact you?!

Yes, it would be very very useful if HVs, and community MWs for that matter, could prescribe basic medicines instead of just referring you to the GP (which for us is a 40 mile round trip). Why can they not do this?

Before DD was born, I'd freak out about how I'd know what to do with the baby. I'd have a moment of sheer panic and then think, its OK the HV will be coming around every two weeks for the first five years. (or some ridiculous idea I must have got from watching medical dramas on TV). This consoled me enormously. I had nobody, no mother or sister to ask. When I realised how little they would come round I was gutted.

In reality, mumsnet has been invaluable for a lot of advice.

However, we do live in an area where the HVs are valued, and they are resourced, and when I have gone to them they have been great, on the whole very supportive and we had the 8 month checks which mums in neighbouring boroughs have not had and I have hears some awful stories from them about how rubbish their HVs are.

So, while they did not live up to my (unrealistic) expectations, when properly resourced and valued, they are invaluable. IMHO.

jaffa my point is that the assumption should be that parents are capable of 'assessing their health needs'. The paediatricians are state-funded, everyone has one. I know that in the UK there is this assumption that because healthcare is state-funded, it can't be state of the art. Well, I disagree its a matter of how much as a society you are willing to pay for it. As for vulnerable families, children get a health pass (in fact the mother gets one when she is pregnant) which lists all the check ups with the paediatrician and if I am not mistaken they are linked to financial incentives to make sure every child is seen.

I think onceamai makes a good point, that there are some hvs who should be in capability proceedings, and dismissed from their jobs. They give the service a bad name.

Unfortunately, there are failing employees throughout public services and whilst (as a Local Authority employee) I've occasionally seen disciplinary proceedings, never have I seen anyone hauled up for failing to do their job properly. Even when it is patently obvious to all that an employee is incompetent. Why is this? I know NHS is different to LA, but my mum is a retired nurse and sounds from her like there are similar issues in NHS

Hello

I just had to post in response to this thread I am health visitor but now work as a NHS manager managing HV services in a part of central London. Health visitors can have between 300-600 under 5's on their caseload they visit all families to make an initial assessment those with no additional needs are then offered the core child health promotion programme which is usually new birth visit, 8 week post natal review, 8 mont and 2-2 1/2 year developmental review. The rest of their time is spent at child health clinics and visiting vulnerable families which includes child protection of which here is lots in most areas of London. In terms of indvidual practice all are registered as nurses and then have additional regiterable qulaification as a HV and yes they must keep up to date. If you are concerned about your HV you must report and feed back as its impossible for managers to know what has been said to each individual mother and family.

Have not read all the thread but have just seen that some more HV's are part of the discussion which is good In answer to gaelicsheep all HV records are transferred to the next HV in another area if the HV service knows about the move which isn't always the case. Most HVs are also qulaified to prescribe from a limited list of medications

I really appreciated my HV after having dd2. She always visited me at home, phoned me up, encouraged me. I went through a fairly shit time and I just appreciated her being around.

And to HVs like ghostly, don't feel bad. I've not read much of the thread but if this has been a rather unpleasant shredding of a particular profession, then it happens regularly on mn. Don't take it personally.

Rusty O6 I'm going back a long time but when I referred my HV to her boss the boss was as incompetent if not more incompetent than the HV in the first place, and a million times more patronising. I had to take it all the way to the CEO of what was then the community health trust before even getting a definition of the hv's role. I still chuckle that the boss told me that the hv's role was to make sure I was communicating enough with my baby to make sure he developed speech. She on the other hand appeared to have grave difficulties understanding what I told her and following my instructions, ie, I wanted no further contact with the HV service after the sheer incompetence I had already suffered. From this thread not very much appears to have improved and unless there is a root and branch review the situation will continue to be a dishonest waste of public money.

I was not prepared to be part of blanket coverage if the service provided was not capable of doing what it said it would do and did not provide me with a benefit. Why else would I accept a visit, no courtesy of making a mutualy convenient appointment, and waste an hour of my time. The "service" has to be worth having if it is to continue. I really don't think it's unreasonable if an HV instructs women to b/f and to immunise to expect the HV to be able to provide evidence based up to date advice about the subjects they are bullying instructing about.