Wednesday, 8 July 2015

Changes in health visiting in Scoland

Phil Wilson quotes the Inverse Care Law.
"The availability of good medical care tends to vary inversely with the need for it in the population served. This...operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced." (Julian Tudor Hart, 1971)
That is, the more need there is for care, the less likely it is to be taken up by those who need it.
This is true for parents with young children but this is where you can get more `bang for your buck,` says Phil Wilson. "The social, emotional and cognitive wellbeing of children in the early years are the strongest determinants for how long they will live and how their lives will be."
Until 2005 there was a comprehensive system of child health checks. Eighty percent turned up for the checks but twenty percent did not and they tended to be the most disadvantaged and to contain the children most likely to have problems.  "Growing Up in Scotland (GUS) research has shown that more affluent families are more likely to seek advice from health visitors and GPs about their children's health."  Universal surveillance checks were stopped because it did not seem to be an effective way of spending public money.

"Getting access to the parents who do not turn up for appointments is very difficult."

A study was conducted in Glasgow using the Strengths and Difficulties questionnaire where high scores showed poor wellbeing. It was found that when scores were compared between children starting school and the same children at seven, the scores of children from more affluent areas such as Hillhead and Partick went down, whereas the scores of children from more deprived areas went up. "Something happens in primary schools that amplifies the pre-existing differentials in social and emotional wellbeing between the most affluent children and the most deprived." (So children with poor wellbeing deteriorate after a few years at primary school. That does take a bit of explaining.)  "There are school factors that play into this," admits Phil Wilson.

"Given this, should we be providing universal services, targeted services or a bit of both?" he asks.

"We got it wrong with Hall 4. Reducing the number of contacts with children meant that health professionals relied on parents reporting problems. But parents do not always know that they or their children need help; and also it is difficult to predict who will need help."

"Evidence shows that using parenting programmes as a universal approach does not work efficiently enough, which means this is not an effective way to spend public money."

"Targeted parenting support can be very effective, such as Family Nurse Partnership and Incredible Years, but they are still limited and there are questions about whether these are getting to the people who would benefit most."

"There are big variations in need for parenting support.
Economic factors are part of the picture, but not the whole picture.
Providing good parenting programmes is not enough. We need to provide universal support which identifies additional need and addresses this with more targeted support. We need to find a way to identify needs and offer support proportionately. Good health visiting can do this. The Scottish Government's new health visiting core programme is a major step in the right direction in re-establishing good relationships between universal services and parents/children. The changes proposed are revolutionary and would take us to something better than how things were before 2005."

"This is a cause for celebration," declares Phil Wilson.

Or is it?

The health visitor with her targeted support will be the Named Person with all the powers of surveillance that that implies.

Here`s a possible scenario:

"How are you?" the health visitor asks.

"Fine," she says a little bit defensively.

"You`re not fine, are you?"

"Yes I am," the woman snaps back.

"No you`re not. There was that domestic incident at the weekend now wasn`t there?"


Yes, the health visitor will learn all about it from the police. How can such a possibility form the basis of a trusting relationship between two adults?

See politicisation of family life

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