How can the professions convey the breadth and complexity of their role to the public and society-at-large? And what benefits might that bring? Journalist Jo Waters reports…
Mention a midwife and – for most people – a picture of a uniformed woman might spring to mind, holding anew-born baby or squeezing the hand of a woman in labour during the most taxing moments. There are tears of joy, moments of drama and labour pains, of course – but there’s a happy resolution that most parents will remember forever.
Thanks to people’s real-life experiences and through long-running popular programmes such as BBC1’s Call the Midwife– now filming its fifteenth series – plus fly-on-the-wall documentary programmes such as Channel 4’s One Born Every Minute, midwifery has a high-profile.
Even if someone hasn’t actually given birth, chances are they understand what midwives do. Vitally, the profession has a positive brand image – midwives are respected as being highly skilled and educated. When it comes to public perceptions of community practitioners however, the picture is much less clear-cut.
CPHVA Executive chair Janet Taylor, a public health nurse manager of a multidisciplinary team at South Eastern Health and Social Care Trust near Belfast, says: ‘I think most people think health visitors just weigh babies and school nurses (SNs) give injections. They have no idea about the complexity of the work we do and how highly trained and qualified you have to be to do these types of jobs.
’The Princess of Wales, whose Royal Foundation Centre for Early Childhood (2023a) made a film about the crucial role HVs play in the early years, hit the nail on the head recently. She said that so much of what HVs do is ‘behind closed doors in people’s homes and much of it isn’t a highly visible service’.
Public Health England (2021) has pointed out that HVs and SNs are the only professionals who engage with all the family in their own home as well as in the community. This crucial relationship, it pointed out, enables ‘early identification and intervention to mitigate problems worsening in the future’.
But do the majority of people realise the vital role CPs play in public health and early intervention – and, indeed, in maintaining life itself? Or are CPs relatively hidden compared to the other frontline professions? How might abetter understanding enhance the CP workforce, by, for example, boosting recruitment? Moreover, what can be done to change the professions’ public image?
WHAT DO THE PUBLIC KNOW ABOUT CPs?
Not an awful lot if a recent snapshot report commissioned by the Royal Foundation Centre for Early Childhood (2023b) is anything to go by. In interviews conducted with4680 adults, Ipsos found that most members of the public(56%) were unfamiliar with the HV’s role.
People associated HVs most strongly with giving feeding support and undertaking health reviews. There was much less awareness about their involvement in mental health, relationships and child development. The report says this shows there is a limited awareness of the breadth and complexity of the HV’s role. Even among parents of children aged five and under, this awareness was limited, with 39%of those polled saying they knew just a little or nothing about an HV’s work and remit.
CPHVA Executive vice chair Asha Day, who managed CPs at Leicestershire Partnership NHS Trust in a previous role, says that some clients view HVs as people who could potentially remove a child from a family. ‘The opposite is true – we work with families on strategies so that they can keep their babies and children’, Asha points out.
‘Even in Call the Midwife, where a HV was featured, she was a nun with quite a brusque manner and her portrayal of a HV’s role wasn’t what we would have wanted,’says Asha.
‘Also, you’ll see midwives in soaps and dramas visiting people at home after the birth and most will, in reality, only be doing that for 10 days and then HVs will takeover – but we don’t see an HV’s work being shown on TV – they’re invisible.’
TIME TO ACT?
Child nursing lecturer
(Leeds), HC, and CPHVA
executive member says:
|‘I think the public’s perception|
of CP practice is varied across
different population groups
as there are differences in
delivery and provision across
the four nations.
‘To improve the perception of
the professions, it should start
at grass roots. And CP roles
should be promoted alongside
other key professionals when
promoting ‘people who help
us’ in school curriculums.
‘The importance of
community practice should
also be embedded into
curriculums. Finally, the
profession should be better
represented in the media.’
Is it time for CPs to create a concerted campaign to improve their visibility to the public as other professions have done so successfully? (see HOW OTHER PROFESSIONS CHANGED THEIR IMAGE, below) And what can realistically be done, without money from government for an advertising campaign, for example?
Asha Day believes a documentary series featuring ‘a day in the life of a CP’ could convey the complexity and importance of CP roles to the public and politicians alike. ‘Health visiting isn’t as fast moving as a midwifery story –the challenges are more long-term, the strategies have to be longer term, but we could pick areas that are most challenging, or our more unusual clients, to highlight the wide range of problems we deal with and that we’re not just about weighing babies. A one-off drama will not work, it needs consistent messages over a period of time.
‘We could also offer up experts as script consultants for dramas and soaps involving babies and children, so we are portrayed in a more realistic way.’
Asha stresses that individual action can make a difference too. ‘My local MP asked to join me on a health visit because he wanted to know what CPs did. He admitted he hadn’t realised the depth and breath of the role and responsibilities of HVS, SNs or community nursery nurses,’ says Asha.
‘We are a tremendous source of good local information for our clients that can’t be found in books or social media – you just can’t buy this.’
There’s also a message to be spread about the importance of the first 1001 days of life. Earlier this year, research from the Royal Foundation Centre for Early Childhood (2023c) found there had been little change in recent years among groups needing the most convincing (non-parents, for instance). One respondent in four believed that children’s development shouldn’t be a priority, given the other problems facing the country.
OWNING THE NARRATIVE
Janet Taylor is convinced that CPs should also be telling their own stories, and mentions that a number of TV documentaries in Northern Ireland have helped them to do so. However, she doubts that the government will fund an advertising campaign in the current financial climate.
She adds: ‘Health visiting is a fantastic job, one where you can make a difference. I would love the world to know more about CP roles and shout it from the rooftops.’
Janet also praised the Institute of Health Visiting for its series of videos highlighting the profession’s achievements and reveals the CPHVA’s website is being updated to offer more information about the work of practitioners.
‘Trusts also have Facebook groups which promote HVs and the groups we set up on breastfeeding. Maybe there’s room for some HV messaging on Instagram and TikTok – but it would all have to be controlled and coordinated.
CHAMPIONS AND NEXT STEPS
Despite the decline in the CP workforce and fragmentation of HV roles in some areas of England – CPs do have some notable cheerleaders.
The NSPCC charity is one of the high-profile campaign groups that consistently champions HVs. Jack O’ Neill, its senior policy and public affairs officer, says that ‘with few touchpoints, HVs provide the only opportunity to engage with babies and new parents in their own homes in this critical period’.
‘But this important safety net is under immense and growing pressure. That’s why the NSPCC is calling on the government to implement an updated and improved Healthy Child Programme alongside an NHS workforce plan that will help give HVs the resources and tools they need to adequately support families right from the start of life,’ (NSPCC, 2023).
The statement highlights an important point – it’s not about trying to change an image in isolation. There are also pressing issues that need to be directly addressed, such as getting the pay right and having manageable caseloads. ‘It’s hardly rocket science to recognise and understand that health visiting, school and community nursery nursing need good investment to thrive in this modern time’, says Unite (health) lead professional officer Ethel Rodrigues. ‘Government must respond urgently to avoid further crisis.’
In the meantime, the Royal Foundation’s commitment to early years is a shot in the arm for the profile and status of CPs. In the video she made about HVs earlier this year, the Princess of Wales said: ‘Families need support now more than ever and it’s so important that we recognise and celebrate the amazing role that HVs play up and down the country.’
Perhaps more efforts such as this could help in the battle against stale stereotypes and invisibility. And, just maybe, as it did for the other professions, a change of image might have a knock-on effect on recruitment, on morale and possibly even in helping to show the government how important CPs are to society.
HOW OTHER PROFESSIONS CHANGED THEIR IMAGE
Several professions have successfully revamped their public image in recent years by combining advertising campaigns, advocacy and media strategies – bolstered by political lobbying. Although most operate in vastly different fields to CPs – they have faced similar challenges, and so could provide some useful lessons.
THE NEW FACE OF FARMING
Cast your mind back 20 years, and farmers were emerging from a national crisis after a major foot-and-mouth disease outbreak.‘ Farmers were really not respected or understood by the public or environmental groups – or even by government and politicians,’ says Jane King, former editorial director of the Farmer’s Weekly group. ‘They weren’t making any money, and their businesses were in dire straits.’
Jane recalls: ‘Farmers were being challenged for receiving subsidies and not doing enough environmentally for the land and wildlife. Agriculture was not seen as an aspirational job or career by anyone. But all that has now been brilliantly reversed.’
The situation started to change when farmer Peter Kendall (since knighted) became president of the National Farmers’ Union (NFU) in 2006. He gave speeches about the importance of reversing the image of farming and getting the public and politicians onside. ‘His message was about celebrating the good stuff and sharing best practice and connecting much more with consumers of their products,’ says Jane.
‘The NFU mobilised the farming industry and various key influential bodies in and around agriculture and used the media to start to change how farmers projected themselves. Money was also spent by the NFU and conservation groups to train farmers to be more media savvy so they could appear as spokespeople for the industry on TV and radio in a sensible way.
’The result was that the narrative about farming began to change – it became about farms producing amazing safe food, what farmers were doing for the environment and being custodians of the land. Farmers were encouraged to hold open days, so the public could see how they managed livestock, national farming awards were launched to celebrate best practice and farmers gave talks in hundreds of schools.
‘Farmers became the champions of the industry – they were people who were trained to be confident to stand up and be heard in the media,’ says Jane. ‘Farming news became mainstream, with documentaries on TV and much more understanding of their work. It probably took 15 years to achieve this – it wasn’t overnight, but drip, drip, it changed the narrative, showing it is possible to change the image of a profession.
|WHAT THE BRANDING|
Holly Hill, marketing director at the
I-COM digital marketing agency,
who helps clients rebrand their
image, identified the following
issues and possible solutions with
the CP ‘brand’.
|ISSUES WITH BRAND|
As a broad group of people with
varied professional skillsets and
working environments, the role
of CPs can be challenging for
the public to understand and
appreciate. With such wide-
ranging roles there may be a
lack of knowledge of just how
significant, far-reaching and
important these roles are for
communities at large.
– Education and awareness
campaign on the work of CPs
– Share success stories – real life
examples of the difference
CPs make to everyday lives of
mothers and babies, toddlers
and school-age children, as
well as those who need home
– Involve service users in advocacy
to highlight how CPs have
– Raise awareness about the lack
of resources for CP and the
impact this is having
– Engage with media outlets to
build relationships and improve
– Address any negative
– Focus on core messaging
for a branding campaign
concentrating on how CPs
empower communities and
transform lives, as well as being
– TV advertising campaign/
‘Farming has repositioned itself as an exciting, vocational, but also professional, technically-skilled job and I think there are some parallels and similarities with what CPs do, in that it’s a vocation, but also academic and technically skilled.’
Jane says all this happened because of constant communication, ensuring that farmers were centre stage telling their own story. ‘Maybe CPs need to be doing the same, so the public understands what they do. Joining forces with other relevant groups and charities may also help get the message across more clearly.’
‘GET INTO TEACHING’
Teaching is another profession that has suffered from an image problem – blighted by unfilled vacancies and an underpaid, overworked workforce. There are some clear parallels with the CP workforce. But an advertising campaign, launched in2018 by the Havas agency on behalf of the Department for Education, managed to work some magic for the profession.
The campaign’s Every lesson shapes a life video told pupil Abbie’s story from her first tentative walk into school to confidently sitting exams as a teenager – thanks to her teachers’ support and encouragement.
Real teachers and schools featured throughout the advertisement. Creative director Lynsey Atkin has written about the campaign’s key objectives (Havas, 2023): ‘Because we all have them, we forget what an enormous and special role teachers play in people’s lives. Somewhere along the way we started only seeing them in terms of exam success and Ofsted reports.
She continues: ‘So the strategy was about spotlighting the incredible role teachers play, not in terms of the job we end up with, and therefore what we become, but fundamentally in the person we become. For those looking to join the teaching profession, there seemed to be no greater incentive than this.’
The campaign featured on hoardings across the country and was reinforced by regular social media and radio items emphasising that teachers help us to become who we are.
According to figures published by the Crown Commercial Service (2020), the Get into Teaching campaign helped to generate an additional 10,000 applicants for graduate teaching places. There was also an 18% uplift on year-on-year website registrations. Could a campaign to change the image of CPs have a similar impact for the workforce?
‘MADE IN THE ROYAL NAVY’
Back in 2014, the Royal Navy decided to launch a long-term, brand-led approach to improve recruitment. The media at the time tended to portray it as a force ‘out of business and a generation who were more familiar with ground-based wars than naval ones.’
The brand agency Wavemaker highlighted a need to make the Royal Navy more visible and relevant to the public (again, similarities shared with CPs), and change a tendency among potential recruits to put off decisions about joining. Wavemaker’s Made in the Royal Navy advertising campaign told powerful stories ‘at scale’ – using TV, radio, cinema and video on demand to create emotional connections and make decisions on joining up easier.
The campaign resulted in more than 2700 new recruits, a 44% increase in people’s ‘emotional connection’ and a £25 million cost saving over five years (Wavemaker, 2023).
Crown Commercial Service. (2020) Case study. See: bit.ly/3OTIKvY (accessed 16 August 2023).
Havas. (2018) Every lesson shapes a life. See: bit.ly/3DUgD9K (accessed 16 August 2023).
NSPCC. (2023) We’re calling for greater investment in health visiting as first visits to new-born babies are increasingly delayed. See: www.nspcc.org.uk/about-us/news-opinion/2023/were-calling-for-greater-investment-in-health-visiting-as-first-visits-to-new-born-babies-are-increasingly-delayed) (accessed 16 August 2023).
Public Health England. (2021) Best start in life and beyond. See: bit.ly/3OwUUcZ (accessed 16 August 2023).
Royal Foundation Centre for Early Childhood. (2023a) The Princess of Wales spotlights vital role of health visitors. See: bit.ly/3DUh8Ra (accessed 16 August 2023).
Royal Foundation Centre for Early Childhood. (2023b) Public knowledge of the early years’ workforce. See: bit.ly/3QHY4Nt (accessed 16 August 2023).
Royal Foundation Centre for Early Childhood. (2023c) Understanding public attitudes towards early childhood. See: shapingus.centreforearlychildhood.org/wp-content/uploads/2023/08/The-Royal-Foundation-Centre-for-Early-Childhood_Public_Perceptions_Survey_third_release_August_2023.pdf (accessed 16 August 2023).
Wavemaker. (2023) Made in the Royal Navy. See: bit.ly/3OX3xPk (accessed 16 August 2023).
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