Health visitors don’t always get good press at the school gates or toddler groups. Among my fellow nursing friends, the standing joke is that I spend my day simply weighing babies. I guess as a result it’s not hard to see why in some areas the value placed on health visiting has fallen so far that the service will be cut completely.
At the moment most councils are reviewing the funding for health visiting amid drastic cuts to public health budgets. Cumbria and Staffordshire are planning on cutting health visiting posts and a number of other NHS trusts have job freezes and have discussed redundancies. NHS Digital reported this year that the number of health visitors dropped in UK by 433 posts.
While perhaps there may be some truth in the comments I so often hear, the reality of health visiting feels very different.
It’s hard to describe a typical day because the one predictable thing is that it is completely unpredictable. I’m never quite sure when I stand at a front door what is going to be behind it. I have a bag full of leaflets and a mental checklist of the topics I’m expected to discuss. As the door opens, I may be greeted with a smile or an offer of a cup of tea, other times by indifference and occasionally with suspicion. Then there are the times when I’m not greeted at all, when I stand on the doorstep trying to find a pen, my diary and a free slot later in the week to return.
As I take a seat on the sofa, I’m aware of the balance I need to strike between raising topics and listening to what families need and want to ask. I don’t always get this right; I feel the pressure of sharing key messages about safe sleeping, coping with crying and infant brain development resulting at times in me talking too much and listening too little.
Within an hour of taking that seat I’m asking personal questions related to health, relationships and parenting. I explain that I ask these questions to everyone, issues such as mental illness and domestic violence are common and do not discriminate. But I won’t pretend that it doesn’t sometimes feel intrusive. I’m hoping that in that brief time I’ve built up enough of a rapport to make these questions powerful because when necessary it’s incredible how much someone can share with a stranger.
Sometimes as I look around the room the poverty and health inequality is obvious. Young children living in damp, mouldy, overcrowded houses. Sparsely decorated front rooms and kitchens lacking basic items many of us take for granted. At other times it’s more subtle. I see families struggling to feed their children during the school holidays because they have had to pay for extra childcare while they work; families having their benefits stopped because of an administration error; families where the main source of income is a zero-hours contract and if the phone rings at 6.30am, then there’ll be work. If it doesn’t there won’t and so today is another day of emergency electricity.
Within an hour of taking a seat I’m asking personal questions. I won’t pretend that it doesn’t sometimes feel intrusive
As I reach into my bag to find the food bank vouchers, the number for Citizens Advice or to make notes on the letter I’ll write to support a family’s application for being rehoused, I try to block out the thoughts that this isn’t enough. As I explain that my letter may not make any difference, that the waiting lists for social housing are so long most children will have grown up by the time they make it to the top, I try not to feel despondent that there is little I can do. As I reassure a mum that none of us are perfect, but she is good enough and explain that I can offer a listening ear and opportunity to access specialist support, it often feels like all I’m doing is putting a sticking plaster on a great gaping wound.
Before I leave, I explain how families can contact me, no question is too small. I’m there until their child goes to school, but unless there’s an extra need, I won’t visit again. I explain that I’ll be at a baby clinic at the local children’s centre every week. I don’t mention how the staff there are unsure about whether they’ll have jobs this time next year, and how the support they’re able to offer diminishes each week as cost savings are made to “streamline services”.
And as I close the door on my way out, I hope that I’ve not missed anything. I hope that the positive and upbeat mum wasn’t putting on a show because she’s scared of what may happen if she tells me how hard she’s finding life. I hope that I won’t get a phone call from social care in few weeks’ time about what’s happening behind that front door. Then I take a deep breath and get ready for the next doorstep.
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Health visitors aren"t valued but we do more than just weigh babies
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