Health visitors'unique skills must be saved, says Woody Caan - and there is a way

Published: 01/04/2004, Volume II4, No. 5899 Page 25

Today, 'health visitor' ceases to be a protected title, the old statutory register of health visitors will end and dissolution into the untried third part of the nursing and midwifery register could produce an incoherent mess of skills, training, appraisal and ethical standards.

Nurses and midwives in the long-established parts of their register have well-understood competences and ethical perspectives, but these are not sufficient. The ethics of engaging with a whole household across the generations or facilitating health development across all ethnic, cultural and political groups in a neighbourhood are different from the ethics of caring for an individual patient.

Entering a strange house with proficiency in working to prevent child abuse and neglect is quite different from reacting to the battered or starved child who presents in accident and emergency.

Observing a recent meeting of the health visiting and school nursing senate, it was clear that many of these 20,000 practitioners (and the educators and students in health visiting) have lost confidence in the proposed regulation of their function.

One possibility is that the function will wither and die as standards are set by people who do not understand or value the expertise, training or qualifications involved. Until recently, this is what I expected to happen. But now I have become aware of an alternative: some people who have paid in the past to register with the UK Central Council for Nursing, Midwifery and Health Visiting/Nursing and Midwifery Council might transfer their details to a separate register. This would maintain the core of skills and form the basis for training new entrants, maintaining continuing professional development.

During this period, a 'college of health visiting'with oversight of professional training and conduct could be established from an amalgam of existing committees and bodies, analogous to the college for allied professionals. Once there are a few hundred public health specialists on this register, the plan would be to join the Health Professions Council, which would have statutory provision for new professional members.

A College of Health Visiting could also be regulated through the HPC. This could include new routes to enter the profession and also increases the chances for coherent, worthwhile planning.

Woody Caan is professor of public health, Department of Public and Family Health at Anglia Polytechnic University.