Health visitor diaries: harrowing disclosures and safeguarding

Two health visitors share their accounts of a challenging and rewarding day

Two health visitors share their accounts of a challenging and rewarding day working with vulnerable families

  • Health visiting services face a backlog of work due to the COVID-19 pandemic and must prioritise the most vulnerable families
  • The number of health visitors in England has fallen by just under one third over the past seven years due to financial cuts to councils
  • Last year, 82% of health visitors reported increases in the domestic abuse cases they encountered and 81% reported increases in perinatal mental health problems

Image: iStock

Health visiting services have been under more pressure than ever during the COVID-19 pandemic, with staff facing a huge backlog of work that requires prioritisation of the most vulnerable families.

These challenges are taking place against a backdrop of reduced staff numbers: financial cuts to councils have led to a 31% reduction in the number of health visitors in England in the past seven years.

Rapid increase in domestic abuse and perinatal mental health problems

In an Institute of Health Visiting survey published last December with responses from 862 health visitors in England, 82% (707) reported an increase in domestic abuse and 81% (698) saw an increase in perinatal mental health problems.

Here, two health visitors offer an insight into a typical day and the kind of sensitive safeguarding disclosures and time challenges they are facing.

‘Claire’ is a health visitor working in the West Midlands

8am I arrive at the office. Since the pandemic we’ve moved to more agile working. It has been challenging to go from the office, with lots of informal peer support, to more lone working, which can make the role feel isolating at times.

8:15am Online GP liaison meeting. We share any relevant information about safeguarding families or any families that either service has identified needs additional support and discuss difficulties our services are facing. I share that we are struggling to meet the needs of the population with increases in parental distress, increased safeguarding, social isolation, and the lack of groups and social support.

8:30am I input all my visits onto the online diary and prepare anything I need for the day’s visits, including personal protective equipment (PPE). Every day is a busy day at the moment and it can feel overwhelming.

9:30am Team meeting: we meet online for 15-30 minutes every day to check in, catch up and talk about our day. With more remote working it’s important to ensure there is a plan in place so all whereabouts are known at the end of the day.

‘We desperately need more health visitors to be able to do our job to the best of our abilities, to build relationships and to identify concerns as early as possible so we can put in interventions to help families’

‘Claire’, health visitor

10am The first visit of the day is a listening visit for a mother with a six-month-old baby. I get out of my car and put on my PPE which I don and doff before and after each visit and go and knock on the door. The transition to parenthood is challenging enough without a pandemic, which has meant that families have been isolated from friends and family leading to low mood. The mother feels she is in a better place and we can reflect on the progress she has made. I leave the visit thinking about the importance of having time to listen in our role and the difference this makes.

Picture: iStock

11:30am The second visit of the day is a new birth contact. This contact is an opportunity to share health promotion messages as well as discuss the birth, feeding and emotional health. The mother tells me that breastfeeding has been difficult and that the baby is not yet back to birthweight on day 14 as the midwives think the baby has a tongue tie. Mother and baby have been referred to the infant feeding team for additional support. We talk about the feeding plan the midwives have put in place, I observe a feed and we discuss positioning and attachment to optimise effective milk transfer before the appointment. I leave her with a plan to follow up next week or to call the office if needed in the meantime.

1:30pm I arrive at the next visit: a ten-month development review. I’ve known the family since the baby was born, so it is great to see the baby growing and developing. Previously the mother has made passing comments about her relationship difficulties but when I have explored this with her, she has denied any domestic abuse.

When I ask about her emotional health today, she breaks down and shares that she has asked her partner to leave the family home. She shares that she has been a victim of ongoing abuse since she was pregnant, but was too scared to speak out. She reveals that us having the conversations throughout her care meant she knew that when she was ready, she could disclose to me.

We talk about support and I share that I will need to make a safeguarding referral. She is open to this as she has read about the dangers of ending an abusive relationship and wants support. I give her the helpline numbers and websites and advise her to ring. I then head back to the office to make the relevant referrals. As I drive back to the office, I reflect that it can take several consultations to build relationships that enable disclosures and for people to ask for help, and how important continuity of care is.

2:45pm My last visit has cancelled and I am relieved as it means I can complete the safeguarding referrals required.

3pm I make a phone call to the safeguarding consultation line for advice and then make a safeguarding referral to the multi-agency safeguarding hub. I share the assessment I did with the mother, which is a questionnaire to determine the risk the person is under due to the abuse.

4:30pm I start documenting the day’s visits and think about the referrals I did not get done this morning that I need to do. The need is high at the moment and we work hard to ensure that all families are seen, and their support needs are assessed – every family that we miss is a family that may need help, support and signposting.

We desperately need more health visitors to be able to do our job to the best of our abilities, to build relationships and to identify concerns as early as possible so we can put in interventions to help families.

Sarah Stevenson, specialist community public health nursing student health visitor in North Tyneside

5:30am The alarm goes off for another day out in practice. I don’t actually start until 8.30am and, with no office to drive to, working from home can feel odd and tiring.

I’m getting up earlier than I am used to for my 12-hour shifts in the hospital as a midwife. However, I have a busy day ahead and assignment deadlines looming, on top of practice experience, not to mention three teenagers to see out the door to school. I also want to do some reading for my evidence-based practice module before I open emails and see what’s new with the team on our Teams chat.

8:15am Reading done, although I’m not sure it’s made things any clearer, kids sorted, and I’ve looked at my ‘To Do’ list. Lateral flow test done – who would have thought a swab up the nose would become an essential part of the work routine? I log on a bit early to check emails. Most of the team is already online, which is no surprise as we are so busy.

8:30am A quick catch up on the phone with my practice supervisor going over my visits and arranging to meet for a joint contact. She’s amazing and has gone out of her way to give me as many experiences as possible and build my confidence.

I wish we could be working together in the office and car sharing to visits. Being separate has brought home how much learning gets done talking things through on the car ride. She has a child protection conference that’s been added to her diary today via video call. This would be great learning for me but I’ll never get home in time from the visits to log on. We agree I’ll go and do a feeding review that she will now have to miss instead.

9:30am It takes 50 minutes to drive to my caseload area, so I always try and plan visits making the most use of my time. It’s easier now with fewer restrictions and we can access more work buildings to use the loo. I meet my supervisor at the family’s home for a one-year review.

‘The baby is almost one now and I’ve been visiting since she was 14 days old, so I’ve seen her develop into a little person. That long-term continuity made me want to become a health visitor’

The mother is friendly and chatty at first, but quickly breaks down when I ask about how the little one is through the night. The baby is a good sleeper but the mother tells us she cannot sleep and wakes with night sweats and terrors. She discloses that she is anxious her ex-partner is now in the area and knows where the family lives. She tells us about the extreme violence and abuse he perpetrated towards her. Just like that, a ‘routine’ visit turns into something different. We talk about safety plans and support.

10:58am I call my other visits from the car and apologise I will be a little late to each. I have an email from the locality nurse manager asking if I can provide some PPE training to some of the school nursing team as vision screening is restarting. It’s on my study day but I accept it as I want to support the team and my manager has shown me flexibility too.

12:25pm Lunching in the car after completing two visits and heading off to the feeding review. I have a few cheese puff crumbs in my hair from a two year old who doesn’t understand masks or social distancing.

‘I take out the envelope the mother had given me earlier. It says: “Personable, professional and kind. Went the extra mile to help, would be an asset to any team.”'

1:45pm Finished my feeding review visit. I love visiting this family – the baby is almost one now and I’ve been visiting since she was 14 days old, so I’ve been lucky enough to see her develop into a little person. It’s this long-term continuity that made me want to make the change to become a health visitor.

The mother has completed some feedback for me for university and hands me an envelope, so I say thanks and pop it in my bag. I jump in the car to get home in time for my training webinar with the Institute of Health Visiting.

4:30pm The webinar was interesting. A pandemic bonus has been working with health visitors from across the country, one of the few more positive things to come out of COVID-19. It’s finishing time but I want to write up my records so I log into the system.

5:45pm I’m about to save my final record when the secure connection goes down. I’ve lost what I’ve written and need to do it again. One of my kids is calling from downstairs wanting their tea. I have a wobbly moment as I’m pretty worn out now.

Sometimes I wonder if I made the right choice taking on a course and new qualification on my own with three children: it’s exhausting. I wait for the system to come back on and take out the envelope the mother had given me earlier. It says: ‘Personable, professional and kind. Went the extra mile to help, would be an asset to any team.’

Those few words mean so much in that moment. Deep breath, and the system is back up and running.

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