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Celebrating ten years of the Institute of Health Visiting

19th December 2022

Continuing our celebrations for the Institute of Health Visiting’s 10th anniversary, Professor Dame Sarah Cowley shares her reflections of the Institute’s first ten years.

Professor Dame Sarah Cowley

How wonderful to be celebrating ten years of the Institute! I had the honour of being a Trustee at the start, then after completing my first term and having a year off, I have started a second term. I was asked to reflect on what has changed in that time, although there was much to consider before detailed planning even began. There had been many years of discussion before a small group of us (more details here) reached a definite decision that we needed to try and set up this Institute. We were largely influenced by two major themes.

First, there was growing evidence of both the need for the work that health visitors do, and of the importance of the early years to future health. Over the last 30 years, there has been an exponential growth in knowledge about early child development. The period between pregnancy and the first 2000 days (until infants are five-years-old) is well-known, now, to be critical to future health. Knowledge about neurophysiology and the development of babies’ brains led the field. Next, came dramatic strides in knowledge about how those early years affect which genes are switched on or not – creating likely future strengths or vulnerabilities for each individual as they grow. And more recently still, we’ve begun to learn even more about the massive, long-term impact of early nutrition on infants’ lives as they grow.

As a country, we are all desperately worried about current pressures on our NHS, with increasing incidences of ill health and growing health inequalities. Yet, the science is there – we have the knowledge to prevent and promote far better health for the population, starting with those very earliest days. And, whilst the body of knowledge specifically about health visiting practice is less well-developed, we do have a lot of evidence about how to turn this basic scientific knowledge into helpful, health-enhancing practice.

Second, paradoxically, as this body of scientific knowledge expanded over the decades, the opposite was happening to the organisations that had previously focused on health visiting. When I first came into the profession, I was registered with the Council for the Education and Training of Health Visitors. That was replaced by the UKCC which was for Nurses, Midwives and Health Visitors. In 2004, the Nursing and Midwifery Council took over from the UKCC, closing the dedicated health visiting register. So, the UK Standing Conference on Health Visitor Education also dropped its sole allegiance to health visiting, adopting a wider remit for Specialist Community Public Health Nursing. The unions had done something similar in the 1990s – first the Scottish Health Visitors’ Association merged with Unison, then the Health Visitors’ Association merged (via MSF and Amicus) with Unite. Each became one part of the wider unions’ ‘health sectors’.

These continuing organisations, and many more (like the RCN and QNI), still all speak for and hold a very valuable brief for health visiting. But finding the distinctive voice of health visiting was increasingly hard for anyone who didn’t know where to look. By the early years of this century, there was no longer a single body that concentrated wholly and entirely on the health visiting profession and its contribution to public health through practice with infants, young families and vulnerable communities. Which organisation should anyone approach, if they wanted to know where to look for evidence for health visitors and the work that they do? Parents, families, press, policy makers (or anyone seeking information) would have struggled to find which amongst the many multi-faceted organisations would provide an authoritative voice about health visiting knowledge and practice. So, one of our primary aims was for the Institute to become that specific organisation – to be an authoritative voice about health visiting’s evidence and practice, and explaining its valuable contribution to public health.

When we started in 2012, there was much excitement and optimism for the future of the profession, as the Cameron Government’s ‘Call to Action’ promised to correct the (then) drastic fall in the health visiting workforce. That meant that our new organisation really hit the ground running – and it has been running ever since. At each Board meeting, the Trustees are amazed at how much is being achieved by the incredible team at the Institute, who are all so professional, hardworking and inspirational. And I think they have achieved that aim to be an authoritative voice, with an extensive and accessible source of evidence-based information about health visiting practice, service organisation, development and research.

I will give you two personal examples of when I called on the iHV in recent months. In the first example, a young relative moved into a new home, some distance from immediate family and friends, but with her partner and three-year old, and shortly before her second baby arrived in June. She had an elective Caesarean, then developed a wound infection and then went down with Covid. Then, to cap it all, her partner’s father (the baby’s paternal grandfather) died suddenly. And the baby cried, and cried. Well, I would too! So much stress for a new baby to process in her first month – and so hard for the parents – but, somehow, they got through those first tough weeks.

Then, in November, I suddenly received a message saying that the baby was still crying – so she saw her GP who just said she’s fine and babies cry (oh!). Actually, he did rather more than that, but the mother felt guilty, “He must think I’m just a worrying Mum! Maybe I’m doing something wrong? I’m feeling very alone and…” Well, any health visitor will recognise the picture. And I’m a six-hour drive away, but panic not! Just reach for those brilliant Top Tips for Parents on the iHV website – all evidence based and beautifully written for parents. She thought the one about crying babies was wonderful and so reassuring that it gave her the courage to go to the nearby baby group, which she’d been avoiding in case the little one cried and then what would everyone think of her as a Mum?

The second, quicker, example concerns a professional query that came to me from a health visitor. Was it true that the five mandated visits had to be carried out face to face now please? Between us we could find Parliamentary Questions showing this to be the Government’s position, but nothing about it in the official guidance for commissioners. Check it out with iHV? You’re right, they said – we keep asking, but it hasn’t been updated, we’ll chase again.

Because, and this is the biggest change in the last ten years, workforce numbers have plummeted like a stone since the ‘Health Visitor Implementation Plan’ finished. We did get the promised additional 4,000 health visitors by the end of 2015 and the iHV was very active in helping to achieve that, but the workforce is now lower than it was when that plan started. There is hope on the horizon again, with the Labour Party promising to restore the workforce with another 5,000 health visitors, should they be elected to Government. That is a useful starting point from which to lobby others. Overall, the Institute has become a formidable force in making the case for more resources, stressing the health needs of babies and families, and collaborating with other organisations to help make the case.

The new organisation hit the ground running ten years ago – and it’s been running ever since! The fantastic team at the Institute of Health Visiting were amazing when it first started. Despite all the pressures that the profession is facing at present, they still are – and they are still optimistic! There are, indeed, very many challenges at present, but the Institute is established as that authoritative voice for health visiting. It speaks out, not just for health visitors, but for the work that they do to meet rising health needs, always using the evidence base and supporting the future health of our youngest citizens and their parents. Very many thanks to them and a happy tenth anniversary to the wonderful Institute of Health Visiting.

Professor Dame Sarah Cowley

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