Select Committee on Health Appendices to the Minutes of Evidence


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 letter—annexed—from 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 was passed:

    "That this meeting of the RCN Congress urges Council to campaign to maintain health visiting as a universal service."

  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 or caseload?

  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 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

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2001
Prepared 28 March 2001