What's a health visitor?

If someone stopped you in the street and asked you the name of your health visitor, would you know?  Ok, so you may not see one right now, but in the UK we’ve all had one at some point - do you remember?

What if they asked what they do - would you have any idea?  To my shame, I’d have blankly shrugged at both questions.

But all this is about to change.  If you believe David Cameron (and why wouldn’t you?), by 2015 everyone will know not only who their health visitor is, but also what services they offer.

Part of my new job is to help recruit my region’s share of the 4,200 extra posts deemed necessary to ensure our Big Society is healthy – and that our pubs remain full of students and our glorious leader remains in office.

So yesterday I left my ivory tower and spent the day with a real, bone-fide health visitor.  It was quite an eye-opener.

The morning clinic was a ‘drop in’, and half a dozen mums came with their bundles of joy.  There was a remarkable range, from a proficient professor clutching recent research to a newly-single mum just trying to hold things together.

Babies were weighed and measured, and growth charted against expected progress in the child’s ‘red book’.  The endearingly old-school health visitor obligingly weighed in kilos, but I could see she was translating back to pounds and ounces!

The old and the new also contrasted in the ongoing use of paper notes, despite electronic records now being the norm.   It may be partly inertia, but in fairness the systems are not yet easy to use.  For example, they don’t link to GPs’ network (how can this be?), and can be painfully slow – if you’re lucky enough to get access to a computer.  Rather than realising the benefits of IT, so far computerization risks adding an extra task to already burdened professionals.

Whilst the influx of new, young health visitors may bring fresh thinking (and improved computer literacy), they will be hard-pushed to match the wise reassurance of the seasoned health visitor. 

Mums often came with seemingly minor issues such as feeding, sleeping and cradle-cap - but there were real anxieties, and were calmly and confidently addressed by someone with such a wealth of knowledge.

And after all, how do parents know how to bring up kids?  Is it innate, or must we learn it?  In the time of Call The Midwife, nearly everyone grew up around children, and had first-hand experience of raising siblings, cousins or neighbours. 

In contrast, families now are smaller and more distant, and parents are a lot older – all reducing our opportunities to learn parenting before we become one ourselves.

There are serious problems too, particularly post-natal depression.  I wondered why I never came across this when working in developing countries.  It’s hardly the kind of western luxury we’re thankful for: a staggering 10% of mums suffer from it in some form – isn’t it something we should talk about more?

One mum was clearly struggling to cope with her hyper-active son, and the health visitor arranged to see her for a longer session the next week.  Another boy was clearly autistic, and through gentle questioning the health visitor identified the issues and helped the mother plan how to cope.

After the clinic, a GP asked the health visitor to visit a family with an unemployed, alcoholic dad, who she feared might be a risk to his children.  It was sobering to learn that just below the surface of seemingly affluent areas can lurk drug / alcohol dependency, domestic violence and child abuse. 

Fifteen years ago I spent a fascinating day with a health visitor on the Craigmillar estate in Edinburgh, and was struck by how even people with troubled and chaotic lives clearly distinguished health visitors from social workers - and they certainly knew their names!

By law, health visitors must visit every family with a new child – so they are uniquely placed to improve health and prevent harm in the crucial first few years of life.

One of the most telling comments I heard from a mum showed the value of parents having access to experienced, dependable, sympathetic health visitors:  “I didn’t know who to go to” she whispered tearfully, “so I came to you”.

Whatever else can be said for the present government’s health policies, they’ve got this one right:  I’m delighted to be helping with this recruitment drive.  But I also hope to support those who are already in post to continue the often remarkable, frequently under-appreciated work of health visitors.