My Lords, the health visitor implementation plan, published last month, confirms our intention to recruit an extra 4,200 health visitors and sets out the enhanced offer to families that the increased workforce will bring. The new model ensures a universal service for all, a rapid response from the health visitor team when parents need specific expert help and ongoing support to deal with more complex needs over time, including services from Sure Start children's centres, other community services and, where appropriate, the Family Nurse Partnership.
I am most grateful to the Minister for that encouraging Answer; it sounds very good indeed. Is he aware, though, that some of the families in the greatest need are very hard to contact, sometimes simply because they are embarrassed by their inability to parent and sometimes because they are afraid that the local authorities, if they hear about it, will take their children away? Is he also aware that there is a strange geographical distribution of the supply of health visitors, which as it stands has nothing to do with need? Will he assure the House that these issues will be addressed in the new plan?
My Lords, the noble Lord is undoubtedly right that in many areas the current health visitor workforce is very stretched. They are there as a universal service but, at the same time, they try to target their efforts to families in the greatest need. Some struggle to do so, which is why we have set this ambitious programme of recruitment over three to four years. It is a very tough target-I do not disguise that from the noble Lord-but we think that it is necessary if we are to focus on the needs of the most disadvantaged families.
Is the Minister aware that many people apparently now view health visitors with suspicion as agents of the state? They are frightened, as the noble Lord has said, of the child being taken away. Does the Minister therefore think that one great answer is the system of adoption whereby children can be fostered by someone who could adopt them if, for example, the drug addict mother does not overcome her addiction, but which also leaves open the possibility of the child returning to the mother? That gives the mother an opportunity to recover. It is a very good scheme and it is in operation in some parts of the country. Would it not be a help in addiction cases?
My noble friend makes a good point. The kind of intensive interventions that she is referring to are very much the domain of the family nurse partnerships, which are there to assist and support those families with the greatest needs, particularly single mothers, families where there is addiction and so on, and try to keep the family together. With regard to the health visitors, however, I take her point that there is suspicion out there. It comes down to creating a relationship of trust with a named health visitor, and we have seen the success of that over the past few years. The results of the assessments have been very positive.
My Lords, when health visitors were attached to local authority services, co-operation between the different arms of local authorities was much easier. In many cases, health visitors are now attached to general practice services. Can the noble Earl assure me that there will be the widest possible consultation to make sure that health visitors can reach out to the community at large, which would be very valuable in terms of public health?
My Lords, the noble Lord makes an extremely good point. The health visitor initiative is very much part of our public health drive. Local authorities will have an important part to play in commissioning services in the future. However, at the start of this big programme of recruitment, it is very important to have a concerted national drive. That is why we have said that it will be the responsibility initially of the National Health Service Commissioning Board to push this agenda forward. Thereafter, we will see much more local commissioning as the programme moves on.
My Lords, given that the Department of Health accepts that the family nurse partnerships-to which the Minister has referred-have been shown through an international report to have a great effect in minimising the maltreatment of children, are there plans to introduce them across the board alongside the implementation plan for health visitors?
The right reverend Prelate draws attention to a very important area. Family Nurse Partnership is essentially a preventive programme for vulnerable young first-time mothers. It complements and supports the work of health visitors, providing intensive care. We are committed to expanding the Family Nurse Partnership Programme for those families and doubling the number of places on the programme by 2015.
My Lords, we hope to recruit nurses and midwives for upskilling from a variety of sources. Some will come out of retirement, we hope, while others will, we trust, come from the acute sector. As my noble friend knows, the trend for a long time has been to try to get care increasingly out of acute settings and into the community. I think that we will see that transfer of skills taking place from a variety of sources.
My Lords, I draw the noble Earl's attention to the document which my department published last month, Health Visitor Implementation Plan 2011-15: A Call to Action, which sets out how we are going to work with partners to deliver our ambition, including, very significantly, the Sure Start children's centres which play an important role in our agenda. However, I will take the noble Earl's idea back with me and be in touch with him about it.
My Lords, what work is being done to improve the training of health visitors to enable them to identify the mental health needs of new mothers, which can impact very negatively on the emotional attachment between mother and child?
My noble friend identifies an extremely important area of the health visitors' remit-to put their finger on where there are problems and therefore to alert members of the multidisciplinary team to address those problems where necessary. The issues to which she refers are very much a part of health visitors' training.