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Positive culture shift

The increase in the number of health visitors means the service has improved now attitudes need to follow suit:

Health visiting is in its prime, and we need to be shouting about it. In my 20 plus years of health visiting practice we have never been in a stronger position to improve health outcomes for children and families. The health visiting implementation plan has significantly increased the workforce, doubling it in some areas. Our profile is high, to the point where we seem to be the answer to all problems and cited in every report about children's health and well being...which is not a bad thing!

We are soon to be commissioned by our local authorities, with the potential to really improve joined up collaborative working. We have evidence to support our practice to an extent not previously seen, with the Wave Trust, which works to end child abuse, and others supporting the service and its potential impact. Our service leads have developed policies and pathways that have helped us to standardise our evidence based practice alongside the Department of Health steer to measure outcomes in a meaningful way. We have an Institute providing national leadership, driving forward quality and excellence in practice. And families want us to visit, they want to see us in clinics and they want to be able to call us for advice. Netmums told us in 2008 how much they valued the health visiting service. At the time we were despondent because there were just not enough of us, but now we are many.

So why is it not feeling like we are in such a good place? Why are colleagues not shouting from the health centre roof tops about their fantastic service? Why is the recent survey report from the Institute of Health Visiting not telling us how good things are and how positive health visitors are feeling about the service? I manage over 130 staff in health visiting teams and have spent the last 12 months trying hard to encourage colleagues to celebrate all that we have achieved in getting the service to the place it is and recognising the great potential for our current and future role in children's health. But as I go from base to base it is often an uphill struggle convincing colleagues of the opportunity presented to us. Experienced staff seem bogged down by the memories of how hard it has been, preventing them from recognising how much things have changed and how far we have come. And all those newly qualified health visitors are recovering from intense training; having to some extent competed for a quality learning experience with so many other students. They arrive in their new teams full of anxiety but also excitement and enthusiasm. But they sometimes have to struggle against the prevailing culture, based on past experiences and how much we couldn't do, stopping them from thinking about how much we can do now that there are thousands more of us.

We need to challenge each other to start focusing on the positive aspects of being a health visitor. Health visitor team meetings and forums need to stop being about what we can't do and how busy we are but about what we can do. I'm often told that the day to day job is not feeling any better despite doubling the size of some teams, because health visitors have more to do. There is more domestic violence, more neglect, more maternal and infant mental health issues. The workload has gone up, we are now doing antenatal visits, new birth visits, six week contacts at home and development assessments at the right time rather than three months late. But this is a good thing; we are delivering a great service and we are out in our communities identifying need and having the capacity to prioritise and respond appropriately.

This is our moment as a service to be the best we can be and truly make a difference, improving people's health, reducing health inequality and making life better for the families and communities we work with. But we must first shift the culture from one where we are focused on the past to a position of pride and expectation from ourselves and our colleagues to make the difference that I know we can make. If we have any hope of convincing our partners, commissioners and families of what we can achieve, we must first convince ourselves. The health visitor implementation plan has worked, we made it happen and now we need to proudly own it and get on with making the difference.