Health visitors are professional individuals engaged in public health work within the domestic setting, predominantly found in countries with state-funded health systems. They are distinct from district nurses, who provide clinical healthcare, domestically. In the UK, since 1945, health visitors are required to be registered nurses, with midwifery qualifications, who have undertaken further training to work as part of a primary health care team.
They are mainly concerned with helping to ensure that people's domestic behaviour is sanitary, hygienic, and beneficial to the welfare of themselves and their families, particularly to their children. As their name suggests, they fulfil their role in the community, by visiting family homes, to give advice and support to all age groups. They have a key role with regard to safeguarding vulnerable people, as they are often the first experts to enter the homes of individuals at risk of abuse and neglect, especially children.
At the time their profession began, living conditions for the urban poor were often cramped and extremely insanitary, leading to many business owners sending women around to workers' homes to educate their wives about sanitation and nutrition; healthy workers were better for economic output. This was formalised as the Ladies Sanitary Reform Association, in 1862, and by 1890 some local councils were paying their salaries. In 1929, they began to be employed by local councils on a statutory basis, although since 1974 they have technically been employed by the National Health Service instead.
In the early days of statutory health visiting, training in the UK was overseen by the Royal Sanitory Institute, who later evolved into the Royal Society of Public Health. This was later taken over by the government's Ministry of Health, and they are now regulated by the Nursing and Midwifery Council.
The initial focus of health visiting was on families with young children, and all mothers were given a statutory right to a visit from a health visitor in the first week since birth, once postpartum care is handed over from the midwives. Visits would cover topics such as sanitation, feeding, nutrition, care, and support to both infants and parents. Typically there would be regular visits throughout a child's early years, to provide routine child development checks; a check at two years of age is now a major part of the standard provision.
Issues of hygiene, malnutrition, or disease, would be corrected with suitable advice, and reported to the relevant authorities where appropriate. If the health visitor suspects that matters are serious enough to warrant child protection measures, it is their responsibility to initiate the process of intervention. The dual role of advice and inspection has made some families wary of health visitors, despite being appreciative of their potential for assistance.
In the 1950s, their interventions were made more extensive to ensure they could provide a cradle-to-grave service, working also with the elderly and chronically ill. However, under the Blair Ministry, with a jump in immigration, their ever-rising case-loads were considered to be affecting the potential quality of interventions in young families. As a result, their work was refocused back to young families; the reduced intervention in elderly care has been accompanied by a commensurate rise in admissions of elderly patients to A+E departments and care homes.
After Sure Start was introduced, to provide general early years support to families, the refocusing on young families lead many health visitors to use Sure Start centres as their base. The Healthy Child Programme, published in October 2009, influences the core service available to families, breaking it down into two age groups : firstly the first 5 years, and secondly 5-19 year olds. The latter age group are traditionally dealt with by school nurses - a public health nurse embedded within, or frequenting a school - with health visitors handing over responsibility to them, for a child's development and welfare, once the child starts to attend school.
The Cameron Ministry has sought to reverse this reduction in scope, giving a commitment to recruit more health visitors, to ensure that health visitors' caseloads are not negatively impacted. The Cameron Ministry's reorganisation of the NHS has returned responsibility for public health, at a local level, to local councils once again, with national issues, and oversight, being provided by Public Health England. Health visitor services will therefore now be commissioned by local councils, in partnership with clinical commissioning groups.
In addition to their early years work, health visitors have now started to run health promotion schemes such as stop-smoking services, and to deliver certain vaccination programmes.
Post-qualification, a 1 year full-time (or equivalent part-time) degree or masters level course.
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