Health visiting services used to be ‘universal’ – health visitors saw all pre-school children as a matter of routine. This was a service that worked. Most new mothers needed no more than a little bit of advice or reassurance. Some needed more intensive support. In some cases, health visitors were able to pick up on more significant problems – a serious developmental difficulty, or abuse or neglect, for example. Importantly, this was a preventative service. It was understood that picking up on little problems as they arose could stop them turning into bigger problems.
That service has gone now, across much of the UK. It’s been replaced by nice, modern, ‘value for money’ services that offer ‘targeted’ input to families in need. The challenge, of course, is that identifying the families who need targeted input before something goes wrong is well nigh impossible.
I came across one small example of this in my own work a couple of months ago. I’m changing some biographical details for the sake of anonymity, but this is a true story.
I’m a speech and language therapist, specialising in working with children with complex needs and children with eating and drinking problems. I received a referral for a little boy of about two and a half. The referral said he had a ‘swallowing problem’ because he would drink milk but refused all solid foods.
I met both parents and the little boy for an initial appointment. The parents loved their little boy to bits. The interaction between them was warm, loving and appropriate. The child was clearly well cared for. His growth and developmental milestones were all fine. There were no ‘social’ issues around poor housing or poverty. There was nothing at all about this family that would have flagged them up as candidates for targeted input.
I took a case history. The child had fed well as a baby. His mother had tried to wean him when he was six months old. The child refused solids. His mother was anxious about this, as she knew that babies are meant to start solids at six months. She therefore force fed him – and force fed him several times a day from when he was six months old right through to when he was two and a half years. The child screamed at every meal, was desperately unhappy, but was made to eat. His mother was upset at her son’s distress, but knew that he had to eat and believed she was doing the right thing.
Unsurprisingly, the little boy now has a significant aversive feeding disorder that will take a while to unpick. He’s also spent two years of his life being made miserable.
What might have prevented this? A bit of routine advice from the health visitor along the lines of ‘Just keep offering solids – he’ll take them when he’s ready’.
There’s nothing particularly unusual about this scenario. The idea that parenting is somehow ‘instinctive’ and all of us know how to do it is wrong. A minority of parents learn what to do from books or the internet. A lot of parents depend on family networks – grannies are a major source of information, although they’re not always right! In the UK in 2008, though, family and social networks are a whole lot weaker than they used to be. That leaves many parents working out what to do on their own. Some parents get it right and some get it wrong. The parents who get it wrong are not ‘bad parents’ – they’ve been let down by a system that fails to provide the necessary support to them and their children.
The CPHVA – the part of Unite that represents health visitors – has done some brilliant campaigning work around the decline in health visiting services. There is still – just about – time to reverse the erosion of health visiting. The Government likes to claim that it’s supporting children and families, tackling inequality in childhood and so on. If it wants to match rhetoric with action, it will issue a clear instruction to Primary Care Trusts to restore a universal health visiting service and will ensure that the ring fenced funding is made available for this to happen.
If this isn’t done, there will continue to be a good deal of unnecessary harm caused to small children and their families.