PROFESSIONAL ROLES
BETTY RAYMOND, senior lecturer in health visiting, Faculty of Health, South Bank University, feels much can be lost over time if practitioners do not have the vision and assertiveness to fight and make the case for what they understand to be good practice. Knowing now that she should have been more vocal, what follows is an attempt to describe some of the values, priorities and practice of a young health visitor more than 30 years ago
Recent attention to 'modernising' the role of the health visitor grieves me. In 1970 I began to work as a health visitor, and my nearest and only manager (the superintendent health visitor!) was 40 miles away from my clinic base. I had a level of freedom from supervision and monitoring which would rightly be unacceptable today. However, that freedom also allowed me the flexibility and autonomy to attempt practice as I had been taught.
Collaborative commitment
Thirty-three years ago my colleague and I developed antenatal classes with the local community midwife, a client who was a qualified physiotherapist, a marriage guidance counsellor and a GP. Our classes were informal, used a variety of teaching strategies, and were increasingly client-led. We involved fathers and 'significant others'. The gains postnatally were evident. We hadn't heard of partnership, inter-professional collaboration, client-centred practice, healthy alliances, flexible ways of working - but we understood that all those things were an intrinsic part of what health visiting was all about.
We held early evening drop-in group sessions in early pregnancy, where working mothers-to-be stopped off for an informal chat. This hugely increased our uptake of the main series of classes.
As far as the birth visit was concerned, it was not often the first contact, as we also routinely paid at least one antenatal visit. We knew that those earliest contacts were most importantly about building the foundations of a meaningful working relationship with each family and that from the start the client's agenda was as important as our own.
It was important to have a clear reason for visiting as a health visitor which didn't duplicate what the midwife was doing and to invest in good working relationships with the midwives so that neither professional group felt undermined by the other.
My colleagues and I lacked adequate preparation for identifying and dealing with child protection and domestic violence. However, we were committed to the notion of working for the long term futures of our clients and placed great importance on sufficient input to build valued relationships early on. Many clients remembered us and contacted us in times of need.
Blurring boundaries
I became aware of a local need among the 'well' elderly (although I had never heard of needs assessment!) - living alone, isolated, on low income. I was told they were 'unclubbable'. I took advice from a local WRVS worker, recruited 12 'well' elderly as a team, and was able to begin a club on local church premises which is still running today.
I learned how to find pump priming funding, how to build the team's confidence in their ability, and the challenges of recruiting a leader/organiser. We hired a bus to bring people who were wheelchair bound, and I found a retired lorry driver to be the regular driver/club handyman. I made sure club boundaries were blurred. I hadn't heard of a 'special' public health approach to practice or of community development. Public health and community development were simply and intrinsically what health visiting was about and this was how they were translated into everyday working.
When an insanitary local rubbish tip needed closing I joined with local teachers, householders and others to fight for the closure. When the company constructing the large new town development left nowhere for children to play safely, I joined other agencies in lobbying, successfully, for some redrafting of the plans.
I was not unusual and those with whom I worked all understood that these activities were as much a part of what health visiting was about as the other activities recently being described as 'traditional'. It wasn't 'better in the good old days' - although the context was different - there was as much scope for poor practice and many of the same problems as today which are still unresolved.
Health visitors were a diverse bunch but there was one thing which was very different then from now. Health visitors had a strong sense of what it was to be a health visitor. When in 1972 the Briggs Report proposed the title of 'family health sister' and began the process by which health visiting was ultimately drawn under the statutory control of nursing, health visitors UK-wide were vociferous and pretty united in opposition.
My sadness today includes the awareness that as a group health visitors are more fragmented and uncertain as to how they regard themselves, and more willing to accept the right of civil servants, MPs, and non-health visiting managers to tell them what they are.
The challenge for health visitors now is not only to find language to share with the wider professional and political world what we value about health visiting and why, but also to use every opportunity to identify and disseminate all the evidence we can to demonstrate what health visiting achieves.
Health visiting began as a public health activity, has its roots in the need to reconcile social, political, environmental, and individual factors which affect the quality of people's lives and health. It begins with the individual and the messiness of individual differences and diversity.
Therefore without home visiting it cannot be effective. But it sees the individual's needs as only being fully understood in the context of the family, the local population, the community and the wider society. If what we are doing has departed too far from this, it might be worthwhile, but it isn't health visiting
[Sidebar]
I hadn't heard of a 'special' public health approach to practice or of community development. Public health and community development were simply and intrinsically what health visiting was about and this was how they were translated into everyday working
