In the first of a two-part series, Amanda Holland gathers together some of the outstanding work by health visitors in Wales during the pandemic, with comment from the chief nursing officer.
Two years have passed since Covid-19 first spread across the world, causing widespread illness and death. Today, individuals, families and communities continue to face unprecedented hardships as a result of the pandemic, affecting all aspects of public health. The long-term impact of Covid-19 is yet to be understood, with the most vulnerable in society disproportionately affected by persistent health inequalities.
Within the UK health visiting professions, the pandemic presented numerous challenges, such as restricted home visits and a depleted workforce due to staff redeployment, absence and retiring employees. The pace and scale of service delivery has been second to none as teams rose to the challenge of continuing to prioritise the needs of children, families and communities, and tackling enduring health inequalities head on.
As CPHVA chair for Wales and specialist community public health nurse (SCPHN) programme manager at Cardiff University, I was in a privileged position to observe and experience how health visitors and their teams demonstrated their crucial role of supporting children and families across the breadth of clinical, social and statutory need. Working tirelessly during such challenging times, with professionalism and autonomy, HVs and their teams created and developed innovative workarounds to ensure that families continued to receive the best possible service.
At the same time, I also witnessed the great dedication and creativity of SCPHN practice assessors and supervisors towards continuing to support the development of student SCPHNs, enabling them to reach proficiency, achieve their awards and become added to the third part of the NMC register as a HV or school nurse.
I feel privileged to be a nurse educator and registered HV in Wales, and as the country’s CPHVA chair I wanted to celebrate the extraordinary work of HVs and their teams in Wales. In collaboration with Diane Massey from the Institute of Health Visiting (iHV), we gained support from senior leads of SCPHN and Welsh Government leads for early years to celebrate the health visiting profession in Wales. We asked HVs to tell us about their journeys during the pandemic and the ways in which they innovated and adapted their practice and the service. This article sets out a snapshot of some of the innovations and workarounds that health visiting teams developed to ensure that families in Wales continued to receive the best possible service during unique times.
Thank you to all those who contributed to this article and those who supported this project, and particular thanks to Sue Tranka, chief nursing officer for Wales; Karen Jewell, senior midwifery officer, Welsh Government; and Diane Massey of the iHV.
SCPHN service manager, Betsi Cadwaladr University Health Board, North Wales
Ceri supported the development of a small immunisation continuity team to respond to the threat Covid-19 posed to the continuation of the child immunisation programme. At the time, primary care teams responsible for delivering the programme in North Wales were facing significant pressure as many GP practices were turned into red zones for the assessment and treatment of patients with Covid-19. Families were reluctant to attend these venues with their infants and children to receive their scheduled vaccinations.
The continuity team involved a collaboration between HVs, school nurses, practice nurses and GPs in Anglesey and Gwynedd. The team worked in partnership with local authority education departments to maintain this key public health service and reduce the pressure on GP practices by providing a safe clinic environment for children. The team was established to take over immunisation schedules and maintain local uptake rates, including safe child health clinics.
HV teams worked flexibly between caseload commitments, sending letters, making appointments, and organising clinics and vaccines. The Gwynedd and Anglesey local authorities helped organise appointed one-in, one-out sessions in ‘clean’ spaces such as school halls in local communities. These large local venues helped observe social distancing rules and, together with the use of PPE and safe clinical processes such as one-way systems and appropriate ventilation, helped ensure local accessibility and reassure parents and staff.
Vaccination uptake continued to be successful through these measures, with excellent rates maintained throughout: more than 450 children were vaccinated over a three-month period during the initial lockdown. Feedback from
surgeries and the child health department was also positive, and HVs found the clinics useful to support families during lockdown. Parents also appreciated the opportunity to speak to HVs about any concerns; many indicated their gratitude on social media:
‘My little superstar was such a brave boy having his three 16-week injections today. Well done to the health visitors being there for us mums daily, making sure our babies are vaccinated while putting yourselves at risk.’
The clinics worked well due to effective partnership working and the commitment of all involved.
Health visiting team manager, Betsi Cadwaladr University Health Board, West Wales
Bethan supported her team as they set up health visiting hubs within the local community. At the time, redeployment of HVs into the acute sector left the service depleted, resulting in huge challenges associated with covering a vast rural area. In response to the Welsh Government’s working directives, the remaining HVs continued to provide a service for families by setting up health visiting hubs within local communities. Teams worked cooperatively to cover the workload, prioritising new birth contacts, safeguarding and aspects of the Healthy Child Wales Programme. HVs adapted their way of working, and this included undertaking many core contacts over the phone and virtually. When Welsh Government working directives allowed, clinics by appointment were set up following Covid-19 health and safety guidelines, where parents were able to attend with their infants and children for weighing, support and advice.
When home visiting was reinstated, families welcomed this, particularly in terms of emotional needs. Parenting groups and activities for families were also reintroduced, including baby massage, pram walks, weaning parties, arts and crafts, and breastfeeding support groups.
Despite the challenges of redeployment during the pandemic, the health visiting service worked effectively through central hubs, corporate working and governance processes, adapting to hybrid agile/flexible working practices, skill-mix teams and virtual platforms to ensure optimum service delivery. Furthermore, data indicates that 96% of core contacts stipulated in the Healthy Child Wales Programme were achieved between January to March 2021.
Bethan would like to thank all of her team for their continued hard work.
Health visitor, Cwm Taf Morgannwg University Health Board
Sarah is a specialist SCPHN HV for the Baby in Mind service, which was established before the pandemic. It is funded by the Welsh Government and has become a core embedded service. The programme focuses on early intervention, working with parents at an early stage to keep families together and prevent babies going into the care system. The service was established in Bridgend as a response to the high numbers of children cared for by the state, with one-third being infants under the age of one.
The Baby in Mind team includes HVs, social workers and family support workers who provide practical help and advice, visiting families in the home on a weekly basis before birth, and up to twice a day in the first six months after birth. The team support families with a range of needs, including housing and benefits, accessing health services, developing positive parent-infant relationships, and giving practical parenting advice such as understanding infant brain growth, breast feeding, sterilisation of bottles, baby changing and baby massage.
The team take a trauma-focused approach, working with families in a non-judgemental way to build meaningful relationships. They apply evidence-based intervention strategies such as GroBrain, the Solihull Approach and Brazelton’s Newborn Behavioural Observations system. Motivational interviewing is used to elicit behaviour change in the clients so they can explore and resolve their own uncertainties.
In 2020-21, 87% of the babies were able to remain in the care of their parent/parents, with 84% of parents initiating breastfeeding. Parental feedback has been very positive:
‘We are now able to understand what went wrong when we were children…it all makes sense now.’
Professional feedback has also been positive:
‘There has been great acknowledgement given to the input of Baby in Mind from both professional and parental reports. Parents continue to praise and express real gratitude for the support, opportunity, encouragement, and belief that they were able to demonstrate their abilities to parent safely, effectively and with love. A real reflection on the amazing work that Baby in Mind provides. You must be extremely proud of the service.’
The service supports extremely vulnerable families to give them an opportunity to parent, where previously they might not have had that opportunity.
Health visitor, Betsi Cadwaladr University Health Board, Anglesey
In Anglesey, Sarah and her colleagues at Flying Start established a baby group to help parents and their children socialise in a safe environment during the pandemic. Risk assessments were undertaken, and Welsh Government Covid-19 safety measures were followed.
Parents were keen to attend, and names were added to waiting lists. The group became very successful, and because of the high demand a second session was added to ensure that no one was left out.
During the sessions, staff were able to promote key public health messages to families such as emotional wellbeing, accident prevention, dental hygiene, weaning, breastfeeding and healthy lifestyles.
The team noticed that because parents were able to access health visiting advice at the group, the number of telephone calls to the office fell. Because of the success of the group and positive parent feedback, the nursery nurse now also runs baby massage sessions as well as a breastfeeding clinic.
The group became very successful, and because of the high demand, a second session was added to ensure that no one was left out
Our CNO for Wales says…
As the new chief nursing officer (CNO) for Wales, I am thrilled to have been asked to contribute to this article showcasing some of the excellent work in health visiting in Wales. We have seen HVs dedicate themselves every day to excellence in care, offering each other – but most of all, families and children – the support, care and compassion in what has been an overwhelmingly tough two years in which to become a new parent.
As senior leaders have come together throughout the pandemic to share best practice and ideas and work in innovative ways, I would like to celebrate their outstanding achievements. As I said in my first CNO annual conference in Wales,
I am so proud to be able to say that I support the very best of our society.
I would like to extend a heartfelt thank you for the times when you have faced adversity and run towards difficulty when others run from it. The work highlighted here is an example of the exceptional calibre of people we have working here in Wales.
I want to reiterate: ‘I see you, I respect you and you are all important to me.’ I look forward to visiting as many teams as I can over the next few months and I hope to hear more examples of exceptional work.
Sue Tranka CNO for Wales
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