FeaturesPart two: showcasing health visiting in Wales

Part two: showcasing health visiting in Wales

In the second of a two-part series, Amanda Holland shares more of the outstanding work done during the pandemic.

Rachel Raymond Health visitor and Flying Start health lead, Cardiff and Vale University Health Board

Rachel supported the development of local health visiting hubs and ways to deliver the Welsh Government’s Healthy Child Wales Programme from 2016. She also supported staff through the Covid-19 pandemic as they adapted to different ways of working and assisted at vaccination centres.

At the beginning of the pandemic, Rachel and her senior colleagues were asked to consider who to redeploy, including managers. Although staff were willing to move, they felt uncertain about working in a clinical environment after having worked in non-clinical roles for many years. A mass training programme was developed to prepare health visitors for acute and primary care settings. Most staff were redeployed to ITUs and midwifery wards or district nursing, while others went to Covid-19 community testing teams and the temporary Dragon’s Heart Hospital in Cardiff.

The redeployments, sickness and vacancy levels caused a 25% staff reduction in the health board’s Flying Start and other HV services. As the pandemic escalated, home visiting ceased and was replaced with telephone contacts. As caseloads became unmanageable, Rachel and her senior colleagues helped develop a hub HV service model. This required Flying Start and other HV teams to work from the same location to deliver the service. HV teams quickly adapted to this new way of working, which involved making telephone and virtual contacts, while visiting homes only when clinically necessary. As a manager, Rachel travelled between hubs and delivered safeguarding, birth and transfer-in lists, notes and PPE.

Throughout the pandemic, Rachel responded to the changing needs of the HV service, the workforce and of families. She remained positive and encouraging to staff, assisted at vaccination centres and trained staff, became a flu champion, and still works extra shifts when needed.

Rachel is extremely proud of her colleagues and of her involvement in the transformation and continuation of a safe and effective HV service.

The redeployments, sickness and vacancy levels caused a 25% staff reduction in the health board’s Flying Start and other HV services

Eleri Stokes Health visitor and breastfeeding lead, Betsi Cadwaladr University Health Board

Eleri works two days a week as a lead for the Unicef UK Baby Friendly Initiative, which involves supporting and training staff as well as auditing practice. During the pandemic, it became apparent that some breastfeeding mothers required extra support. Eleri established a weekly breastfeeding clinic in January 2021. She received referrals by HVs, who requested specialist breastfeeding assessments. Following a full assessment, a plan was developed to support the continuation of breastfeeding. Having been trained to assess tongue-tie, Eleri was able to triage and make appropriate referrals to the tongue-tie clinic where necessary. Previously, the clinic was receiving many inappropriate referrals, which was causing a strain on the service – especially during the first wave of Covid-19. 

Eleri’s breastfeeding clinic reduced the number of inappropriate referrals and enabled breastfeeding mothers and HVs to receive timely guidance and support when needed. 

Claire Townsend Health visitor, Cardiff and Vale University Health Board, South Wales

In response to the pandemic, Claire and colleagues developed a central telephone advice line for South Wales to continue to support families through a single point of contact. The line was staffed by Claire and two other experienced HVs on a rota basis, and they provided advice and support to families that were usually cared for at home by HVs. The advice line was staffed from 9am to 5pm, Monday to Friday. Calls taken covered a broad range of topics, including breastfeeding, financial support and advice, and various medical conditions. HVs triaged calls, making referrals to other agencies, signposting to other services and arranging home visits where clinically necessary.

The advice line received over 300 calls per week from clients, other health professionals and social workers. HVs staffing the line were able to provide advice for 72% of the calls they received and refer them to appropriate services. Only 28% of contacts required further support through a home visit. While a number of the board’s HVs were redeployed to secondary care, those who remained worked in hubs. The advice line enabled these HVs to focus on essential health visiting care, including new births and safeguarding children.

Feedback indicated that clients were satisfied with the advice line. An indirect benefit of the service was the triage role, which reduced demand on other NHS services. Unlike traditional caseload management, one of the biggest challenges was that HVs staffing the advice line took calls regarding a wide range of issues and topics. Therefore, it was essential for HVs with varying knowledge and expertise to support one another.

HVs triaged calls, making referrals to other agencies, signposting to other services and arranging home visits where necessary

The advice line’s success has encouraged plans to expand it throughout the board. It could be staffed by qualified HVs on a rota and would provide families and key agencies with quicker access to HV services. This would align with other agencies that have also started to work in this way.

Tina Taylor Health visitor and early years integration team coordinator, Hywel Dda University Health Board, Carmarthenshire, West Wales

An early years integration team pilot project was established in October 2020 between Hywel Dda University Health Board and Carmarthenshire County Council, funded by the Welsh Government. It consists of HVs, midwives, family support workers, a speech and language therapist, a performance and finance officer, and a health board coordinator. The team covers a large area that has poor infrastructure, transport and commerce.

The project’s aim is to support parents and enable children to have the best start in life; to strengthen the community by helping families gain confidence in accessing support when they need it; to reduce health inequalities; and to work in partnership with health services and the local authority, as well as charity and voluntary services to create a joint approach in supporting families with young children.

One-to-one support

The project has supported many families during the pandemic; it received 220 referrals between October 2020 and March 2021, and 230 between April and October 2021. It has provided one-to-one support for parenting issues such as sleep and behaviour management, as well as various group activities, either virtual or face-to-face when Covid-19 safety regulations allowed. These included language support, baby massage, virtual singing groups, walking groups, family fun days and support for mental health issues such as anxiety and postnatal depression.

Feedback has been positive:

‘Thank you so much for all the support you have given me and [my child]. It has been lovely to have someone to talk to. I was very alone because of Covid and I couldn’t see my family for help and advice, but you came and helped me understand my child’s development and I am now more patient’ – Isolated mum.

‘The best thing I ever did was call; we were in a dark place before the leaflet came through the door. You have been really helpful, and we are over the moon’ – Mother suffering with depression.

‘It was lovely watching [my child] play with other children as this has not been possible with the pandemic – thank you’ – Family fun day attendee.


The pathfinder project is highly compatible with principles such as child protection, health promotion, preventing ill health, and promoting equality, family inclusiveness and empowerment. There is an emphasis on individual and community resilience and keeping people well, so that they can live productive, healthy lives. 

Amanda Holland, CPHVA chair for Wales, says…

It’s been such an honour to celebrate and showcase some excellent examples of health visiting in Wales, in collaboration with the Institute of Health Visiting, and with the support from senior SCPHN and Welsh Government leads for the early years. 

We have seen excellent examples of how HVs and their teams collaborated and worked in partnership with others to develop innovative and creative solutions to prioritise the needs of children, families and communities during such challenging times.

In part 1 (Community Practitioner May/June issue), we heard how HV teams joined forces with primary care teams to ensure the continuation of vaccination uptake and how HV hubs within local communities prioritised new births and safeguarding concerns. When home visiting was reinstated, we learned of the relief of many parents as parenting groups were reintroduced too. The successes of the Baby in Mind Project, established before the pandemic in response to the high numbers of babies cared for by the state, was highlighted too.

In this final part, we’ve learned how the development of a breastfeeding clinic enabled timely and effective assessment of concerns, how an early years integration team pathfinder project was successful in supporting many isolated families, and how HVs established a successful telephone advice line during the pandemic, enabling them to focus on what was essential. It was even suggested the advice line could be rolled out across the health board in the future, which could well be a beneficial additional service to home visiting. However, workforce numbers must increase to meet demand and ensure families receive the best possible service.

Finally, we’ve heard about the changing needs of the health visiting service and how to remain positive and encouraging. Indeed, care and compassionate leadership is key, not only during difficult times but throughout day-to-day practice.

As chief nursing officer for Wales Sue Tranka said in part 1, HVs dedicate themselves to excellence every day, caring for each other, but most of all – for children and their families. 

Thank you again to all those who have contributed to this project. It’s been an absolute pleasure to work with you and hear about your successes and your passion, dedication and determination to provide the best possible service.  

Image credit | Shutterstock


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