A day in the life of...a health visitor

The council commissions Public Health Nursing 4 Slough to provide a range of services for the 0-19 age group.

It is now one year since they took over the contract from a previous NHS provider and one of the changes was bringing staff from different sites into one building.

A team of health visitors, nursery nurses, healthcare assistants, community staff nurses, admin staff and school nurses are now based in an office on the Slough trading estate. With the variety of work going on, there is lots of coming and going and there is flexible working, with technology meaning staff can write up notes on the go from a laptop or tablet.

New systems have also been put in place so staff spend less time at a computer. What once took an hour to report a new birth, now only takes 10 minutes.

Operations manager Debbie Rowe said: “When we took over, I don’t think anybody realised how big the transfer would be. Child protection is still a major part of our work but public health is a big focus, particularly in school nursing.

“The commissioners in Slough Borough Council have designed a service that meets the needs of Slough.”

One element of the team’s work involves visiting secondary schools where students can drop-in to discuss any concerns around bullying or relationships, for example.

Nationally there is a shortage of health visitors. The organisation, which is part of Solutions 4 Health, has started to train its own school nurses, which are also in short supply – there are just two in the borough.

Most health visitors are originally registered nurses or midwives. They then have to complete a one year degree in primary care to become a specialist public health nurse.

The Citizen editor, Ruth Cross, spent a day with Sarah Shell, who is a health visitor with 12 years’ experience.

Mum-of-four Sarah transferred over from the previous provider of 0-19 services in Slough and has previously worked as a paediatric nurse in Guy’s Hospital in London.

Sarah often works with people in refuges or bed and breakfast accommodation, helping to signpost them to local health care services. The job also involves working with others such as speech therapists, paediatricians, social workers and voluntary organisations, including HomeStart Slough. They also work closely with Slough’s 10 children’s centre, promoting their services to parents.

Sarah said: “There are lots of things for the under fives; the services they provide are really good. We really encourage our new mums to register at the children’s centres - there is one within walking distance for most people.”

The best bit of the job for Sarah?

The variety.

She said: “It’s nice working with young families. They are all different and all have different needs. It is actually quite a privilege because there are not many services welcomed into people’s homes! You can go in and see how people are living and what life is like for their children. There are very few professionals who have that opportunity and it works well. You do get some people who don’t want to work with you, but most families appreciate it. A lot of people have the idea that it is going round having cups of tea and weighing babies, but it is really not. It is all about safeguarding – we are here to make sure the children are safe and growing up in loving homes.”

There can be challenging times where Sarah has to make a referral to social care, or frustrations when families aren’t making the progress they can, and sadness when action has to be taken because a child is not safe in their home.

It is all part of this varied and important role, where no two days, or even two appointments, are the same!

The universal health visiting offer is five visits, but for some families they are offered more frequent home visiting, depending on the need.

10am – The first visit was to a family with two children who are receiving monthly visits under a Children in Need social care plan. One of the concerns was the consistency of things at home and the safety of the home. This time the house was more messy and disorganised than Sarah’s previous visit, so she encouraged the parents to get on top of things and work together to ensure the home is safer for their children, particularly as one will start to crawl soon. The parents’ relationship was fractured and Sarah had to check they were both mindful of arguing in front of the children. The health visitor role seems to involve being a listening ear, an advisor and a support system. Mums and dads can ask questions and Sarah has plenty of knowledge to share. In this case she was talking about the Healthy Start programme, giving advice on bedtime routines, listening to any concerns the parents had and advising accordingly and she was also able to make a referral to the Slough Foodbank so the family has a three day supply of food provided.

After this visit I see how trusted health visitors are and how you have to be level-headed, compassionate and non-judgemental. The main aim is to make things better for the children. On this occasion Sarah will be speaking to the social worker involved with the family to say she is unhappy and things are taking a backward step. This may then lead to a more intensive support programme for the family.

The next three visits of the day were to families with newborn babies and we were given a warm welcome at each.

10.45am – Health visitors usually visit when a baby is between 10 and 14 days old. This is to check everything is going well generally, to see if there are any concerns or worries, such as around breastfeeding, and to give health promotion materials. They then return when the baby is six to eight weeks old.

This visit is to a first time mother who had an emergency C-section and a five day stay in hospital. The baby boy is 12 days old and doing well. Sarah asks questions about how the mum is feeling, how her C-section wound is healing, how the feeding is going and checks the parents know all about safe sleeping. There is a red book called the personal child health record, which each new parent is given. This is a record of all the important things that need to happen from birth onwards. It’s where the baby’s weight, height and vaccinations are recorded. It also enables parents to write down any illnesses or incidents the baby has, any medicines taken and it has a developmental milestone section too.

Sarah goes through some elements of the red book and points out particular things to the mum. She offers advice on bathing the baby, highlights a checklist about hearing milestones for the child and explains the Healthy Start programme. The mum also raises concerns about vaccinations so Sarah chats to her about these.

12noon – This visit was to second time parents, with a nine-year-old and an 11 day old baby. How the mum is feeling is the first question, followed by how the feeding is going. Sarah mentions breastfeeding clinics where mums can go for some more help and support. The visit follows the same pattern as before, highlighting key points in the red book, the importance of taking a Vitamin D supplement so there are no gaps in the diet, and checking if the parents have any questions. Each family is also reminded of the 111 service for if they have any medical concerns that don’t require a 999 response. A future visit is arranged and details on the baby weighing clinics are passed on. The proud father offers us a chocolate as we leave!

Slough has a diverse community with a huge number of different languages. Health visitors need to know in advance if the mums can’t speak or understand English, so they can arrange to have a telephone interpreter available for their visits.

1pm – It’s a brief stop in the office for a cup of tea and lunch, while Sarah catches up on her emails.

1.40pm – The final visit of the day is to a baby girl who is one of five children. The family is lovely and so proud, with all the kids doing their bit to help mum and dad. There’s not much they didn’t know after having four kids before, but Sarah did talk to them about her feeding and reassure them they were doing the right thing regarding some dry skin on the baby. On this occasion Sarah did weigh the baby, and advised on future clinics they could go to.

2.30pm – I leave Sarah to it while she makes a follow up call to a social worker and writes up all her visits. As she says herself, the day flies by and it is never boring!

Shadowing Sarah for these visits really makes me appreciate the differences in families and all the things they have to deal with, such as their own health conditions or that of their children. Everyone is trying to do their best and it is lovely to see such trust in allowing someone into their home at a deeply personal time in their lives.

One thing was obvious at the end of the day – there is a huge sense of pride in the work being done. It is so worthwhile and a valuable help to families in Slough. Not everyone has a huge support network around them, so having a friendly health visitor pop in to check on things and to be a listening ear really is appreciated by the families.

To find out more about health visiting and the other services for ages 0-19, visit the Public Health Nursing 4 Slough website or call the duty line from 9am-5pm on 01753 373464 if you need to speak to a health visitor.


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