APPG on Sure Start Children’s Centres AGM
Health Visitors and Sure Start
Houses of Parliament, Committee Room 17, 15:00-16:30, 18 May
2011
Attendees
Baroness Armstrong (represented), Annette Brooke MP (chair), Kate Green MP, Sharon Hodgson MP
(vice chair), Baroness Howe, Andrea Leadsom MP, Earl of Listowel, Steve Rotheram MP
Also in attendance
Emily Austin (4Children), Vera Azuike (Parenting UK), Sally Batley (Department of Health), Julie Evans
(4Children), Malcolm Evans (Nursing and Midwifery Council), Cathy Galvin (WCC), Louise Harrington
(NLH Partnership), Judith Howells (Grandparents’ Association), Paula Jones (Lisson Green
Community Nursery), Nigel Lloyd (NLH Partnership), Anne Longfield (4Children), Glynis Mates (Leyf),
Wendy Scott (TACTYC), Andrew Sharp (NCT), Ben Thomas (Unison), Eleanor Thompson (4Children),
Roger Thompson (Nursing and Midwifery Council), Chris Waterman (Investors in Families), Emma
Westcott (General Teaching Council)
1) Welcome from Anne Longfield on behalf of Annette Brooke MP (Chair). Apologies were given on
behalf of the group’s chair who was obliged to chair a different meeting and welcome to all
attendees.
2) Sally Batley, Head of National Implementation, Department of Health – Health Visitor
Implementation – Making Vision Reality
Health visiting is the government’s only target for growth, as set out in the coalition agreement, and
there is a significant opportunity to improve and develop health support. . The growth targets for
health visiting involve increasing the workforce by around 50% (in order to do this, it is estimated
that approximately 6000 health visitors will need to be recruited over the course of the plan).
The Department for Health has been consulting parents on what they want from their health visiting
services. As a result, services are set to be more community based; working with Sure Start,
volunteer groups and other infrastructures already present in local areas.
As a result of these enquiries, the Department of Health has produced the Health Visitor
Implementation Plan 2011-2015: A Call to Action. This report lays out the plans for growing the
workforce, professional mobilisation and aligning the delivery systems. It is envisaged that for all
families health visitors will highlight the services on offer to them (Sure Start Children's Centres etc)
and implement the Healthy Child Programme. There will also be two levels of increased support –
universal plus and universal partnership plus. Under universal plus, parents will be able to access a
rapid response for specific problems such as postnatal depression, weaning or parenting concerns.
Universal partnership plus will target families with more complex issues by providing ongoing
support through health visitors in partnership with local services such as Sure Start Children's
Centres, charities and the Family Nurse Partnership.
The Department for Health is beginning to implement these plans by building the profile of health
visiting, supporting the implementation of the new health visitors by developing and embedding an
enhanced offer and workforce skills, growing the workforce through improved recruitment and
retention and ensuring quality by improving commissioning of the Healthy Child Programme.
There are currently early implementer sites aiming to deliver the new service model and family offer
by March 2012. It is hoped that the lessons learned during this exercise will give implementers the
chance to spread good practice from pilot areas. The programme is aiming to reverse the traditional
way of working (looking at what is wrong, solving problems, identifying gaps) and adopt an assetbased way of implementing the new health visiting services – looking at what is already in place and
finding out what can be built upon, amplifying what works and exploiting existing assets and
resources. But what this looks like in practice will depend on local services. It is hoped that having
had the early implementer sites will mean that the Department is able to demonstrate how local
commissioners and their providers can implement the service model effectively to ensure stronger
local partnerships and more effective working nationwide.
Recruitment for the new health visitors has already begun, with the DH attempting to both attract
nurses and school leavers into the profession and supporting former health visitors to return to the
profession as well as those trained health visitors who have left the profession
Sure Start Children's Centres will play a vital role in the new set up, acting as a focal point for families
and working as a means of reducing health equalities among those groups less likely to visit other
health services. The DH is working in partnership with the DfE to find ways to promote health visitors
working in and through Sure Start centres and with Sure Start outreach workers.
Discussion:
The group suggested that the Department consult with mothers to ensure that the health visiting
service which would be provided would be what parents want. Ms Batley replied that they were
already consulting with online communities of parents but that they would consider setting up a
separate group of mothers to feed into the process.
The Family Nurse Partnership was highlighted as a good example of community working and Ms
Batley was asked whether the new cohort of health visitors would fulfil the traditional health visitor
role or whether they would be more flexible. Ms Batley confirmed that some of the learning from
the Family Nurse Partnership programme would be incorporated into the new health visitor
programme.
Concerns were raised that parents are more likely to confide in Children’s Centre staff – in particular
those involved in outreach activities – than health visitors because health visitors are seen as
“professionals” and some families therefore find them less approachable. Ms Batley confirmed that
the new health visitors would be working with already-existing service structures in local areas to
understand what is required of them in a particular area. They will not be an additional service, not a
replacement.
The issue of professional identity was raised, with the group questioning who would be leading the
early years/health/education teams in communities – will this be a Children Centre Manager? Ms
Batley said that where leadership of the new teams will come from is something that will need to be
explored. There needs to be someone to make sure he right things happen at the right time, she
said.
3) Roger Thompson, Director of Policy and Standards, Nursing and Midwifery Council (NMC)
The NMC is the statutory regulator for nurses and midwives and have around 16,000 health visitors
on their register. They work to safeguard the health and wellbeing of patients and the public by
setting high standards of education, training, conduct and performance. Health visitors already play
an integral role in delivering early years services, focused specifically on providing continuity in
health and social care to all families from birth to schooling – working to build relationships within
communities.
The current workforce is suffering from a lack of recruitment and investment, with an aging
workforce – 20% are over 50-years-old – and 6,000 registered members lapsed. Although health
visitors are already carrying out an early intervention and public health role, they are increasingly
being deployed to undertake local authority safeguarding roles due to lack of numbers. The plan is
to increase the status and make the most of the critical preventative skills of this workforce.
The NMC has been working to address this by ensuring education providers understand the
flexibility they have to train more health visitors, quickly, while ensuring health visitors are trained to
a standard that means they are safe to practise.
Under the public health white paper, health visitors will “have a new role in building a stronger local
community, in partnership with local voluntary and community groups”. In doing this, health visitors’
roles will need to change and expand and the NMC will work to support that.
Discussion:
There was some concern among members that there may be some disconnect between the services
offered by local Children's Centres and those provided by health visitors leading to duplication and a
lack of clarification over who is the co-ordinator in early years services.
Members also reinforced the importance of knowledge of child and brain development as part of
health visitors’ training. Mr Thompson agreed that although this was part of the syllabus, sometimes
health visitors found it difficult to put into practice because of caseloads.
Caseloads were then highlighted as a major factor affecting the skills and knowledge which health
visitors are able to put into practice in the field. Mr Thompson agreed that the council would have to
be aware of the risk of losing traditional health visitor skills in the face of the increased role in public
health which health visitors will have to take on.
He was then asked whether empathy – the ability to knock on people’s doors and engage with them
– would be a course requirement. Mr Thompson replied that this was firmly on the curriculum and
that under the new training programme there was a much stronger emphasis placed on community
practice.
4) Elections of Officers
Annette Brooke MP was confirmed as chair, nominated and seconded by Sharon Hodgson MP and
Kate Green MP.
Sharon Hodgson MP was confirmed as vice chair, nominated and seconded by Kate Green MP and
Andrea Leadsom MP.
Andrea Leadsom MP was confirmed as vice chair, nominated and seconded by Kate Green MP and
Sharon Hodgson MP.
5) AOB
None
Meeting closed.