Dr John Garner: Health visitors deliver a service, let's not lose it

Published on Monday 19 January 2009 18:23

NOW that the festivities are over, we can start to look at the year ahead for the Scottish Health Service. I wish to talk about health visiting and the review of community nursing being rolled out.

According to the website Careers Scotland, health visitors, or "public health nurses" as they have been renamed, "advise and educate people on health matters, and monitor the development of babies and children. They work in the community, visiting people at home. They are usually attached to a health centre or doctor's surgery and take specialist training after qualifying as a nurse."

The reality, however, is far from the glowing picture our leaders paint. It is almost impossible to recruit health visitors at present – morale is low and health board managers tell me sickness levels are high.

Part of the reason for this is, not only the severe shortage of workers, but a seismic shift in patterns of work. Much of the time spent by health visitors is now directed to families with problems and children at risk of abuse.

Before Christmas, the media was full of stories about Baby P, and in Scotland we have also seen some tragic events over the years.

Health visitors have been at the forefront of surveillance and preventative work, and when things go wrong they inevitably feel that blame is directed at them by health bosses. Now evidence is emerging that this shift of workload has repercussions in other areas of child care.

The Royal College of Speech and Language Therapists has collected information from its representatives in health boards around Scotland. It noted a trend for later referral of children requiring advice on speech and language development, and also a possible drop in numbers of referrals from health visitors.

One possible conclusion is changes to the role of the health visitor have affected their ability to monitor children's development as effectively as before. Obviously, this has significance for large numbers of our younger generation and implications for the education system.

I wish I could now bring some good news, but unfortunately not. There are two further issues that may compound the difficulties health visitors experience. Firstly, the decision to decouple health visitors from general practices and health centres and base them in geographical clusters.

We saw this last year in Greater Glasgow and Clyde, where 22,000 patients signed a petition opposing the plans. Similar shifts are happening by stealth in other areas of Scotland, the alleged purpose of which is to spread the remaining health visitors more evenly. In doing so, however, we lose the single point of contact for parents, the liaison with the rest of the health care team and we will struggle to maintain the communication links that are vital to protecting our most vulnerable children.

The second issue is the imminent abolition of health visitors as we know them. The Scottish Government plans to amalgamate district nursing, health visiting and school nursing and is piloting this change in four areas.

The new peripatetic community health nurse may well be appropriate for rural Scotland, but is unlikely to be a winner in urban areas. That's perhaps why both NHS Greater Glasgow and Clyde and NHS Lothian have been reported as getting cold feet about the redesign.

At the end of the day, we must be mindful of the wants and needs of patients. Some insight into that was given in a Mori survey commissioned by Parenting Across Scotland last September. This concluded: "Health visitors are seen as an important part of parents' support networks and are well regarded by parents. Parents feel health visiting services should be available to all parents rather than being targeted only at those experiencing problems".

Maybe we do need health visitors who specialise in child protection, but we also need the traditional health visitor, attached to general practice, delivering for countless mums and kids. The government should listen to the people and professionals, not just the civil servants.

&#149 Dr John Garner is a member of the BMA's Scottish Council and a practising GP.