Toolkit for health visitors

The policy context and current guidance

The role of health visitors is an integral one within NHS community health services. The aim of the health visiting service is to promote the health of the whole community and to help in promoting healthy lifestyles, addressing concerns about physical and mental well being, with the key principles including:

The search for health needs
The stimulation of an awareness of health needs
The facilitation of health-enhancing activities

The National Health Services Act provides the legal framework for the provision of preventive and school health services including the provision of health visitors. As professionals in their own right it is, under the legislation, up to an individual practitioner to judge whether instructions or arrangements place them in breach of the common law duty of care or the Nursing and Midwifery Council (NMC) code of professional conduct.

Whilst being independent practitioners with broad responsibilities, national targets and pressures on services are focusing the work of health visitors towards key areas and government targets. These are focusing their work with individuals on a minimum number of child health development checks.

In respect of working with individuals and families health visitors work within the frameworks and guidance set out in:

Working Together to Safeguard Children
Department of Health Framework for Assessment
Health Visitor Practice Development Resource Pack

The implications of the first two of these documents in relation to practice around parental alcohol misuse – and particularly in respect of child protection matters - concern a wide range of professionals and are discussed separately. See Addressing child protection

Current guidance
The Health Visitor Practice Development Resource Pack has a specific section on alcohol. It states:

‘Alcohol is a factor in many of the priority health issues that health visitors need to address, including mental health, coronary heart disease, stroke, accidents and some cancers. Problem drinking can also severely affect the well-being of families through its association with child abuse and neglect and domestic violence. Serious drinking during pregnancy may give rise to foetal alcohol syndrome. Health visitors can raise the issue of alcohol intake in a non-stigmatising way, particularly as part of a family health plan.’

The guidance suggests that health visitors can:

Advise on sensible drinking
Be aware of local agencies that can help with alcohol related problems
Feed in information about gaps in services to policy makers
Become trained in delivering brief interventions
Work with families to reduce the impact of problem drinking
Identify particular at-risk groups
Contribute to or initiate awareness raising
Ensure care programmes are in place for pregnant women with alcohol problems
Get involved in a local multi-agency forum.

However, little practical information or help is given to enable health visitors to do these things. Despite being expected to advise on alcohol issues amongst a plethora of other issues, neither their nursing nor community health training covers this issue in any depth, if at all.

The specific aim of this series of toolkits is to provide practical information to enable professionals to support children affected by problem drinking parents. However, given that health visitors are mostly focused on the needs of families with very young children, guidelines for health visitors also embrace work on alcohol misuse directly as a means of supporting children.