How do I go about declining a health visitor?

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I'm 33 weeks pregnant with my first DC and was just wondering if anyone might be able to give me some advice about HVs. I'm having the baby in the private wing of a hospital that is outside of local authority and so far I haven't heard anything about a health visitor. I'll get a couple of home visits from a midwife after the birth and don't wish to have a health visitor. I have heard too many horror stories about their ignorance in very basic baby matters (the most recent being a friend of mine being told to google her baby's wind problem) and resent the idea that the government has taken such a nanny state role in parenting.

So my query is, does anyone know who assigns the HVs? Is it the local authority or the hospital? How do I opt out?

Thank you!

With dc 1,2 & 3 the health visitors didn't really do much and I saw very little of them.

Dc 4 had problems at birth and a cleft palate so I saw more of her health visitor, she didn't do much but she was lovely. Sadly we've moved area and her new health visitor is not as good.

Even after being told that dc was under a specialist cleft speech therapist who was over the moon with her speech insisted on referring her to normal s&l as she said she couldn't understand her at her 2 year check. At this point dd could link 4 words together and people who didn't know her could understand the majority.

Anyway I ended up taking her and the a&l person couldn't understand for the life of her why she had been referred. Total waste of time.

So with this baby I'm either going to change docs to try and get a different health visitor or opt out. This is my 5 th baby so I have a bit of an inkling of how they should develop/ what to do if they're windy/colicky and I really don't feel the need for one.

I'm not sure how you opt out.
DS couldn't have his injections due to an autoimmune disorder and even that raised 'red flags' for them. I had to attend a meeting with the GP and put it in writing and sign it - so I guess you would have to do something like that. Be aware that they won't talk too kindly of you in your child's medical notes. From my experience anyway. When the midwife visits come to an end she will say she is now signing you off and you will get a health visitor ring you to arrange an appointment, just express your wishes to not have one and ask if they'd like it in writing or if they have another procedure.

They really aren't all that bad. They are medically trained but to be honest that's not where they helped me most. It's things like awful sleep patterns, night waking, weaning and other problems you experience with a baby that a consultant/paediatrician won't be able to help you with - so for that they are useful.

My health visitor was absolutely amazing and would offer to attend appointments with me regarding DSs illness and also make any phone calls or communications for me. If you opt out before even meeting your health visitor you may regret it as you do not know what issues you may have in the future.

I take issue with the "unqualified" bit. All Health Visitors are qualified nurses. Mine has been to visit as I was suffering some depression after losing my job. We had a good conversation, she came back three weeks later and I could have phoned if I was struggling in the mean time. She really helped, and was very professional and helpful.

And she was not an unqualified person - she was a nurse who had specialised. Like they all are.

I didn't use my HV for any medical advice (my dr is a hospital consultant and most of our friends & neighbours are drs including several paediatricians and GPs) I used mine for all the other niggles & as a sounding board for those crucial 'oh my god I have a tiny baby' moments that come when you have your first baby. As much as you think you know, you read, other people tell you - you have no idea what it's like until your baby actually arrives.

I declined the services of the HV team. They are my colleagues and I know how "qualified" they are! They are all nurses or former MWs and if you knew what a load of old gossips they were, you wouldn't want them anyway near you or your baby.

I'm not a great fan of the HV service, based on the ones I actually had.

Buti think you do need a toe hold on the service. Your MW won't be interested in your 3mth, 6mth, 18mth+ 2yr+ and your GP won't act on issues before they require a medical (as opposed to general care) intervention, and a paediatrician just won't know the answers (asminkr wobbles of ordinary infant care simply isn't their remit).

OP: if you can afford a private HV-style service (you do not seem to have I all covered on your current plan) and know which bits you are opting our of, then fine. There's no single right way (let alone best way) tocarecor infants. But better to make choices from an informedosition. Not one of ignorance.

A lot of bollox talked on this thread, in our area at least having the Health Visitor service does not ensure you see a qualified anything.

Advice given, even by qualified staff, is not necessarily that which is advised by the NHS.

Although some individuals are beyond reproach others accept freebies from baby milk replacement companies and privately denigrate breastfeeding mothers.

Bullying tactics are also used to those who decline services, it is not nice.

And no I'm not naming & shaming, I may have to work in the area again.

Down here in south west you don't see the one u are allocated till 36 weeks, unfortunatly my dc2 is the same as dc1 I had post natal depression after first and didn't want to see health visitor my dr said if I was to refuse her shed would get social services involved and I knew what that involved so I duly did, my health visitor is rubbish, I saw her for 4 weeks after birth every week then didn't bother going only for the check ups u get a letter for and dnt plan to see her much with dc2, I was told by midwife I couldn't opt out so might not b a option

Farm* how does that work then?
My best friend is currently on her 3rd year at I I doing child nursing to become a health visitor - if everyone doesn't have to do this then how is that fair?

I had a private midwife and a not yet qualified one.

The private one could have killed my baby and caused me numerous medical issues.

The not yet qualified one handled a birth where both parties' lives were at risk and did brilliantly.

Private does not always mean the best.

To be fair, meditrina, my HV wasn't interested at any of those points either, and any requests/please for help or advice were hospital-passed elsewhere.

I've no doubt others have been brilliantly helped by their HVs. But let's not pretend the service is universally good or even universally adequate.

(And I realise you're not saying that it is amazing -sorry!)

Just don't opt out of anything before your baby is born - you'd be burning your bridges really. It doesn't mean that you can't 'opt in' again but just don't rush into anything.

God forbid if your baby has any birth problems that may need future intervention - your HV can be worth their weight in gold if you need access to services such as Portage, SALT, special needs support etc.

HV can offer as much or as little as you need when you have a healthy baby - think of them as an On Demand service!

I've no idea how it works presumably they are employed on the same basis as any unqualified nursing assistant types. Paid less so cheaper for the Trust.

I work in the children's sector and do wonder why the service has such a mixed reputation, given that HVs should be at least as qualified as, for example, GP practice nurses, who seem to have no such negative reputation.

Why is that?

The service is certainly poorly resourced in many areas, hence the big drive to get numbers up, so I think they have suffered from being a service which needs to be all things to all people - high impact child protection work and reassuring nervous first time parents.

There is a research report from a unit at Kings which flags up some of the reasons for poor retention and patchy provision within the health visiting service:

Workforce nearing retirement
Years of underinvestment
Some disincentive to train as a HV when the pay scales were realigned under agenda for Change e.g people would have to take a pay cut to train

www.kcl.ac.uk/nursing/research/nnru/publications/Reports/Start-and-Stay-report-FINAL.pdf#page21

They also did another report about service users' views, which was also interesting to read - generally favourable.

This is just what I have found from a quick search.

This might also be a less popular view, but wasn't it true to say that the academic entry requirements for nursing were much less stringent in years gone by? Therefore, some of the older HVs who have older style nursing qualifications plus HV training might find it quite challenging to grapple with the wealth of evidence available on, for example, infant feeding.

I've seen nursery nurses on occasion. Can't say I ever got advice from them.

The first appointment was just about information, lots of brochures etc and information about things locally.

If you don't get any benefit from that and want no further contact just phone and cancel on the contact number you get given.

I work mainly within NHS as a dentist so not NHS bashing am generally very supportive of NHS but of course you can opt out no-one has to be treated by NHS in UK, I am not offering an opinion on HV's I am just supplying information about policy; confidentiality etc I do not like patients or people in general being given mis-information to indicate to them that something is compulsory when in fact it is not or threaten with consequences that would not normally happen as a result ( over-egging the pudding)

it annoys me when the NHS does it but also when the police, teachers JSA advisors etc or just councils looking for irrelevant information like race or sexual orientation when borrowing books or enquiring about waste disposal

the OP does not have to accept any service or as a parent get any service for her child whether this is wise is another question altogether if something went wrong her decisions maybe questioned but in all probability everything will be fine

a simple turning down of a service does not merit social services involvement there would have to be concerns over and above that

however failure to get medical dental treatment your child requires in certain circumstances amounts to neglect, not getting them weighed does not

I imagine 99.9999% of health visitors are employed by NHS if you are seeing a private GP and private paediatrician they will not be informing NHS of the birth even ( in fact if you ask they do not inform your NHS GP they would have to have good reasons to break confidentiality, reasons would include concerns re you or the baby) as you may not have NHS GP as well

legally in UK the only thing OP needs to do after baby arrives is register the birth within the legal time frame

I was under the impression that if a health visitor is not yet qualified but in training they had to make you aware of this and then you could obviously decline their visits and request an already qualified health visitor?

My HV has been utterly brilliant. I've had a tough time for various reasons, still ongoing, and she has been a great support. My experiences have left me pretty scared of HCPs and where their involvement might head, and she's understood that so given me support suited to my needs. I wouldn't burn your bridges in case you do need them. By all means keep the system at arms length if needed, but don't completely avoid based on not very much.

I also found the HV rubbish, and I hate being told what to do and being patronised so I think she found me difficult as well.

Before we had DS, a HV in training came round and after introducing herself, she asked if we'd had previous bad life experiences such as rape or incest. Seriously that was the first thing out of her mouth. We got rid of her quick and got sent another one, but I think they were miffed that we'd refused to let the original one come back.

I would advise smile and nod on the first visit, and make yourself in available for any further visits.

I was only visited once by our local health visitor. They were happy I was managing ok and just asked that I popped to the local clinic regularly for weigh ins and that was it. They are just there to help but I come across so many people who seem to view them as an enemy for some reason.

I think all this has been covered but I just wanted to add my experience.

With my first child as a baby I found the HVs at best, pointless and harmless and, at worst, upsetting and incorrect - eg the ones that tried to force me to formula feed and told me my fully bf ds was "failing to thrive" because he was on the 2nd percentile. They wouldn't listen to me when I told them the graphs in the red book were based on WHO formula fed data rather than graphs for breast fed babies (as they were at that time 10y ago). He wasn't. He, and I, are just little and he is now a perfectly healthy 10y old, a head shorter than his peers. This was extremely damaging to a first time mother trying to bf in the face of much negativity. Everything I learnt about bf and looking after a baby I learnt from NCT classes and friends.

On the other hand, the one that came to the house after the birth was perfectly pleasant and helpful and gave me the red book which I think you really do need. The 2 and 3 year checks were also inoffensive and quite helpful. They cover things which I think you would really struggle to get a private paed to bother with - developmental milestones for a normal child etc.

With dc2 we saw them a handful of times, dc3 twice (get red book and 2y check). I really think this is your best course of action rather than officially opting out.

I do agree with you though, a healthy baby with 2 MC professional parents probably has little need for HVs and with anything medical, I went straight to my GP and referred to paed if necessary. My dc2 had a heart murmur and has hypermobility and dc3 had silent reflux and now has lactose intolerance (both of which the HVs spectacularly failed to pick up on). I got referred to a paed through my GP.

However, I am not sure what kind of access you have to a private paed, but after the birth, in this country at least, I think it is quite difficult to see them without being referred by a GP first? I have private healthcare through work and use a private clinic for vaccinations. I have seen a private paed for the conditions mentioned above. All these people referenced the red book (history of birth, weights, vaccination record etc) - GP, paeds (private and NHS) and private clinic for vaccinations. They also updated the records there.

For this reason, I think it is best to stay in the system, get the red book and then just don't go and see them if you don't find the HVs of any use. Round here they only come to your house once after the birth to drop off the red book - rest of the time you go and see them if you choose to, so no imposition really.

One more thing you might want to consider - again depends on your situation, many private paeds also work in the NHS and, as specialists, see very, very sick babies there. They can be a bit scathing when well-off MC Mum turns up with a relatively trivial problem that she gets immediate access to a paed for through private healthcare - I am not sure how yours will take to having appointments booked up with you asking about breastfeeding, teething, weaning etc?

I think the reason some see them as the "enemy" (although I wouldn't use that term) is that many people get to the point where they have children without anyone associated with the state setting foot in their homes or otherwise interfering in their lives. E.g. I have never claimed benefits so other than the info on my tax return, the state knows nothing about my finances or lifestyle. If I have a health issue, I take myself off to the dr (often preferring to pay to go private so I can choose the person I see and the time I see them) and see them in their surgery. So the idea of a state employee coming into my home when I haven't asked for support is completely alien to me and seems intrusive and unwarrented - if I want support I can ask for it. And as HVs can and do make SS referrals, they are making some sort of judgement about your parenting and lifestyle, and no one likes to be judged!

I'm just one example, but I think that some of the things I've mentioned indicate some of the reasons HV threads usually get a negative reception on MN (this one being an exception).