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Q&A: Health visitor Rachael Hearson on her confessional memoir



We chat with health visitor Rachael Hearson about why health visiting is misunderstood, the impact of Covid-19 and her new book, Handle With Care: Confessions of an NHS Health Visitor.

Why did you want to write the book?

It seemed to me that there wasn’t anyone on the ground in the profession speaking for us in a way that was representing our day-to-day experiences. That’s what I really wanted to get across.

Other healthcare professionals – such as doctor Adam Kay, and his book This is Going to Hurt, and nurse Christie Watson, and her book The Language of Kindness – have joined the national narrative about what’s going on in the country, but not health visitors.

I didn’t know why health visitors weren’t part of the conversation despite having so much to offer to the national and political debate. Health visitors witness grinding poverty every single day as well as the lack of resources to address these extremely sad situations. Midwives do an amazing, important job – and then they handover to us. The reality of life can really kick in at the point when health visitors join.

So I felt it was really important that health visitors had their say. I’m encouraging anyone in health visiting to speak up because what we see is so important. What we see is not normalised either. I think most of us are constantly outraged, and feeling lots of turmoil, and probably overwhelmed sometimes, dealing with lots of competing priorities. Everything pervades the families we visit and there’s a lot of adversity and people are heroic in the way they deal with things. It’s our job to advocate for them – whether that’s by sorting out that foodbank voucher or finding other ways to help them financially. 

Why did you want to become a health visitor?

I suppose that when you look where I started, it was inevitable that I was going to do something to address poverty and advocate for people’s housing. I think my first memory was watching these cockroaches coming in and my mum having to deal with it most mornings. Then we moved to the next house where I lived until I became a nurse, and the house used to flood with m monotonous regularity. My mum would be getting buckets to remove river water. It was unusual. We didn’t go without food, but I could see from my peers who had indoor loos and holidays in Spain and things like that.

I became quite political at an early age. You develop a radar of what’s just and what’s unjust. Looking at illness and cancers and life and death situations, you realise very early on in your nursing career that life is very unjust for many people, but health visiting gives you a tangible vehicle to advocate for families in difficulties. You work with families, walk alongside them, and enable them to experience life in the best way they can.

You say in the book that health visiting is misunderstood. Why do you think that is?

I think it’s because our work is kind of invisible. We also work largely with women, children and babies. Maybe there’s a feminist perspective there that needs to be looked into. Maybe we don’t see ourselves as terribly important. But I think the value of what we do is immense, so I feel very sad about us being invisible and perhaps undervalued.

There’s a lot more thought and intellectual rigour applied in our work than’s sometimes assumed. We’re seen as a professional friendly service, so it’s quite easy to minimise the importance of what we do. Someone might think we’ve just come in for a chat, but there are so many things we cover and look out for. It’s really important that we make sound, correct judgements in out work.

What do you want fellow health visitors to take away from your book?

Speak up and speak out. What you see does inform the national debate and the politics of the day. Families may be struggling – and have long waits for talking therapies or housing letters. If we’re worried about a chid who needs to be assessed for ASD, there’s a year wait. Becaasue we’ve identified that need and there’s a huge delay in getting it, sometimes we get caught up that it’s our fault it’s a delay. But actually we’ve done our job in identifying that need. There’s a huge gap, so let’s go to Parliament and speak up about it.

During Covid-19, it’s even trickier to refer families to services. Although it is getting better, nothing has been functioning as normal, so we’re carrying quite a lot of stress at the moment, all while trying to work with personal protective equipment. Lots of families haven’t had our support. We’ve had to be discerning about the families we go out to. Some of them we’ve had to support in order to avoid bigger problems in the long run around mental health and abuse.

How have health visitors responded to your book?

My colleagues have been incredible supportive. I think other professionals have looked at it and said ‘well there’s a lot of herself in there’. But I felt I had to be open about who I was and where I came from. I think there’s an impression that health visitors are born with a silve spoon in their mouths and we’ve never really encountered real problems in our lives. But actually some of us have come from material poverty and real hardship. Some health visitors really get it and say they totally understand the book. I think there might be a few who think ‘oh god that book is too personal’ and I respect that too. I can’t be anybody other than who I am. 

Rachael Hearson joined the NHS in 1979. She has worked as a nurse, a midwife and, for the last 30 years, as a Health Visitor. She used to work in inner-city London, but now lives – and continues to work as a Health Visitor – in Dorset.

Handle With Care: Confessions of an NHS Health Visitor is available as an eBook and in print.