Traditional health visitor role ‘eroded’ in new safeguarding focus

Dame Donna Kinnair said she feared that campaigning carried out by her following the Victoria Climbié Inquiry had inadvertently led to health visitors being used primarily for safeguarding duties.

“It’s a real sadness for me actually when I think about the unintended consequences”

Donna Kinnair

She told Nursing Times it made her “grieve” to learn that parents were going to psychologists for support with issues that had previously been the “bread and butter” of health visitors, such as potty training.

“It’s a real sadness for me actually when I think about the unintended consequences of some of the campaigning we did,” the new chief executive and general secretary of the RCN said during an interview with Nursing Times.

Dame Donna served as a nurse advisor to Lord Laming during his high-profile inquiry into the 2000 murder of eight-year-old Victoria, who suffered horrific abuse at the hands of her great-aunt.

In his report published in 2003, Lord Laming highlighted how multiple health professionals and social worker had missed a series of chances to intervene before Victoria’s death. 

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Dame Donna Kinnair

In light of the findings, Dame Donna fought for nurses and particularly health visitors to take a greater responsibility for child protection. 

However, she expressed regret that, as an “intended consequence” of this work, some areas of the country were now using health visitors only for this purpose. 

“It feels to me as though the services that we had, that talked about how you get children eating well, living well, pre-school, seem to have been eroded,” she told Nursing Times.

Dame Donna added: “To put child protection as a component part of health visiting never meant to erode everything else.

“It’s a great source of sadness for me when I see boroughs stipulating that only children that are on the child protection register, or who have concerns, are visited by health visitors, as there is so much more they can do for the normal family,” she said.

Reacting to her comments, Obi Amadi, lead professional officer for health visiting at the union Unite, said safeguarding had always been a key part of the roles of health visitors but the Victoria Climbié Inquiry put a new focus on it.

She agreed that previous “bread and butter” duties were no longer carried out by health visitors. However, she said this was because they were being delegated to lesser trained members of the team due to workforce shortages.

“Because of the way that the health visitor numbers have been reduced, it’s not been something health visitors have given away, it’s been something that’s been taken away because of rationing and given to other members of the team, that’s why we are in the situation that we are in, said Ms Amadi.

Latest figures show health visitor numbers in England have declined back to levels they were at before a successful government initative to boost numbers between 2011 and 2015.

Cheryll Adams

Cheryll Adams

Cheryll Adams

Likewise, Dr Cheryll Adams, executive director of the Institute of Health Visiting, said the changes in the role of health visitors highlighted by Dame Donna were “an inevitable consequence” of budget cuts and falling staff numbers.

Commissioning of health visitors in England were transferred from the NHS to local government in 2015.

Since then, budgets from central government to local authorities to deliver health visiting and other core public health services has fallen year-on-year.

With resources squeezed, health visitors had to prioritise families at most urgent need, Dr Adams noted.

“Whenever health visiting numbers fall, their service inevitably gets targeted for the most vulnerable children and that’s obviously the right thing to do, you wouldn’t want vulnerable children to be missed,” she said.

“But what’s happened is the preventative work of health visitors, which Donna’s referred to doesn’t get done,” she added.

Dr Adams noted how social services were struggling with similar constraints and, therefore, the threshold that health visitors had to meet to referral a child had been raised.

“The other thing that’s happened since they’ve gone to local authorities is that social workers are equally under pressure, money has come out of child care basically,” she told Nursing Times.

“So what’s called the threshold for accepting referrals from health visitors, we’re told has tended to go up,” she said.

“The skills of health visitors are much, much broader than child protection”

Crystal Oldman

Crystal Oldman, chief executive of Queen’s Nursing Institute, backed Dame Donna’s comments. 

“Health visiting has changed greatly in recent years with child protection and early years becoming the main focus of the work of the health visitor in many areas,” she said. 

“The skills of health visitors are much, much broader than child protection and encompass community development work as well as expertise in child development, health protection and health promotion in families and the wider community,” she added.