Health Visitors: evidence and immunisations

What do Health Boards do when something works very well? Change it, of course.

Health visitors are the senior and specialist nurses who work in general practice and take a special interest in new mothers and children. While a generation or two ago women might have had physically close relatives with whom to share information and concerns about children with, this is no longer commonplace.

Health visitors usually run ‘drop in’ clinics for parents to discuss concerns about their baby such as feeding or colic. This provides an easy to access and trusted source of information, which is supportive without over-medicalising problems. Health visitors ensure adequate information is given about immunisation, and ensure this is done as recommended. Health visitors help diagnose and treat postnatal depression and support families. Close working relationships with GPs mean that concerns about a child’s or mother’s health can be quickly identified and helped. Such relationships are one of the successes of modern primary care. Immunisation rates in Scotland are high, and are one of the most evidence based and effective healthcare interventions which we have to offer.

Because of the work health visitors do, they may pick up on concerns related to child or domestic abuse.  Health professionals have duties to protecting children. Because of the trust between health visitors and patients, and because of the longevity of their relationship, health visitors are sometimes told things that no one else is.

The Health Visitor Review, written by NHS Glasgow and Clyde wants to change the way that health visitors work. Instead of working from within primary healthcare, they are to work from social work departments instead. In defence of its proposals, the Review says that “Giving the immunisation injections does not require the specialist skills and training of a health visitor”. I could train someone to give immunisations in ten minutes, but this is hardly the point. Whether any parent would then present their baby to recieve them is another matter. The evidence says that the current system of immunisation is working very well. There is no evidence for any better method, yet NHS Glasgow want to change it. No one seems to have asked patients what they would prefer. Dr Phil Wilson, a Glasgow GP has critiqued the evidence which the health board used, and also some evidence which they didn’t. He concludes that evidence shows that health visitors should “maintain a clear identification with the health service” and that “health visitors should continue to give immunisations in practices” and indeed, that these “consultations should be longer”.

There is another real fear. Are mothers really going to ask for informal advice about their child when it is a request that will have to go through the social work department? Will mothers feel able to ask for help with addiction, alcohol misuse, or mental health problems when their health visitor is part of the social work team and not the primary healthcare team? The worrying thing is that we may not even know which problems we are missing.

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