Letter from the Policy Adviser, Royal
College of Nursing, to the Clerk of the Committee (PH 14A)
Further to the oral evidence given by the RCN
to the Committee's inquiry into public health, I would like to
offer further clarification on two points raised by Members.
Regarding the question on the relationship between
nursing and health visiting, the RCN firmly believes that nursing
is an important and necessary prerequisite to health visiting.
It is important both in terms of the knowledge and experience
nurses bring to a health visiting career, and also in terms of
public perception and expectation. We are certain that prior qualification
as a nurse brings a particular credibility and understanding to
the health visiting role from the public point of view.
Several Members raised issues concerning universality
and selectivity in health visiting. To clarify this, I enclose
a letterannexedfrom a former Chair of the RCN Health
Visitors Forum to our 6,000 health visitor members setting out
the definitions and key points around universality, uniformity
and selectivity by health visitors, which I hope will be of interest
to the Committee.
Please do not hesitate to contact me should
you require further information.
19 December 2000
To all members of the RCN Health Visitor Forum
Dear Health Visitor
At the RCN 1998 Congress, the following resolution
"That this meeting of the RCN Congress urges
Council to campaign to maintain health visiting as a universal
The RCN has, of course been involved in vigorous
campaigns in several areas of the UK where reductions in health
visiting services have been threatened (or taken place). The purpose
of my writing to you as an RCN health visitor member is to gather
UK-wide information on what services you as a health visitor are
actually able to provide at present, what you feel would be desirable/needed
in your area.
A related issue which the Health Visitor Forum
Executive committee has discussed and debated at great length
is the definition of a universal health visiting service. We believe
that a universal health visiting service is one which should be
accessible to everyone and therefore relates to the whole population
of a community or general practice list, not just those aged under
five years and their parents/carers. We feel an important distinction
needs to be drawn between universal and uniform service provision.
Uniform service suggests everyone receives the
same input regardless of individual or community need. While some
elements of the health visiting service are uniform and should
remain so, eg primary visit, developmental assessment and health
promotion at key stages of childhood, we do not believe that "blanket"
or "routine" home visiting for all is the mainstay of
modern health visiting.
We believe universalism should offer equity
of access but aim to promote equity of health outcome rather than
equity of input. This approach is dependent upon health visitors
judgements and assessment of individual and community need, and
identifying the best method by which local families and communities
can be supported. In other words using a range of methods of home
visits, group work and community development. For example, health
visitors may facilitate groups for mothers and toddlers, the recently
bereaved, older people (and so on); Run clinic sessions such as
child health, well women, asthma; lead and take part in community
led health initiatives such as literacy schemes, road safety,
domestic violence awareness; and undertake home visits including
those to families in high need (eg child protection).
We would very much welcome your views on any
issues raised here and in addition would appreciate any information
in response to the following questions.
1. How does your employer define your workload
2. How do you define your workload or caseload?
3. What is the size of caseload?
4. Tell us about your ability to offer your
caseload (as defined in 1 and 2 above) a universal service.
5. Can you identify areas of unmet need/practice
outside your caseload? Please specify.
6. Have there been any reductions in HV
service establishment (number of posts)?
7. What prevents you from undertaking work
outside your caseload/undertaking a public health approach to
meet health needs? (eg contracts, GP list and so on).
8. How can the RCN Health Visitor Forum
best support you?
PS We are also interested in the experiences
of specialist health visitors, some of whom may work in settings
such as hospitals eg paediatric liaison health visitors, diabetic
liaison health visitors, designated child protection nurses. Please
do respond even if you feel not all the questions apply to you.
NOTE: As reported extensively in the Press,
the Government has recently launched a consultation document on
family policy entitled "Supporting Families"
(applies England and Wales only). The document makes extensive
reference to health visiting practice (p11-13 "An Enhanced
Role for Health Visitors"). The RCN Health Visitors Forum
wants to know your views on this document, and I would be grateful
if you could send me your comments on this document in addition
to the questions outlined above. "Supporting Families"
is available from the HMSO Stationary Office, or on the internet
http://www.homeoffice.gov.uk. The closing date for comments is
31 January 1999. We will be running consultation workshops on
"Supporting Families" with the RCN School Nurses Forum
in various locations in England and Wales. Details will be sent
to you via a separate mailing.
7 December 1998