Managing the health visiting workforce in a time of transition

Visiting nurse loading equipment into car

Health visiting (HV) celebrated 150 years as a profession in 2012. Although it has experienced many changes to its status, and responsibilities in this time, the workforce is continually facing new challenges. 

Among these, are the fact that the Government’s Health Visiting 'Call to Action' ends this year, and that commissioning will transfer from the NHS to local authorities (LAs) from October 2015. The NHS will continue to employ health visitors (HVs), but services will be commissioned by LAs. 

The HV workforce is an ageing one. HV managers are grappling with the challenges which come with many of their experienced staff retiring, and a large influx of newly qualified workers, many of whom have never practised before. Numerous other factors, such as mobile working, and nursing supply issues bring management challenges with them.
NHS England's recently published 5 year forward view for the NHS places emphasis on the need for greater investment in public health, community care, and early years to prevent costly, detrimental longer term issues and hospital admissions (NHS England, 2014). Things like this can be seen as opportunities for the profession, which contributes greatly to all these outcomes. But the quality of management, leadership and engagement of the HV workforce during this period of transition will be crucial to how opportunities are harnessed, risks contained, morale and, most importantly - excellence of service is maintained.

NHS Employers recently held workshops with our Health Visiting Share and Learn network. We considered what was changing for the workforce, and how managers, teachers and health visitors themselves can support each other to continue to provide a great service to their communities, despite the change happening around them. These are some of the pointers the groups came up with:

  • Above all, provide good (responsive, consultative, fair and inclusive) leadership to health visitors.
  • Review recruitment and selection processes, and strengthen your induction and preceptorship offers, to ensure you are getting the right people into the service, and supporting them as they make the transition from student to professional. Have a look at our guidance about recruiting people for their values and preceptorships
  • Work with the relevant departments in your trust to ensure that pay structures, HR policies and practices, and reward systems are fair, equitable and sustainable.
  • Engage with HVs to agree a shared vision which everyone can relate and work to. Communicate and engage with them about it throughout the transition and beyond. Use our staff engagement toolkit to review and enhance how you engage with your workforce. 
  • Identify what motivates and demotivates your staff, through your engagement with them. Consider different ways of working to help them feel valued and appreciated. Visit our Total Reward pages for advice and guidance about this. 
  • Make HVs’ work meaningful (by measuring and articulating its value), offering career development opportunities, flexibility and celebrating success. Listen to our podcast about how HV morale and retention have improved at Lewisham and Greenwich NHS trust by offering staff flexible working arrangements and career development opportunities. 
  • Use tools such as NHS change model, or John Fisher’s transition curve to help anticipate change and reactions to it, and ask the workforce what they need to help them achieve the shared purpose. Support them through it. 
  • Build productive partnerships and make sure you as managers are aware of the context you are working in, and changes which will affect your workforce. Speak to old and new commissioners about the HV service, to demonstrate its value to the local community. Some service providers have been holding celebratory events which serve a dual purpose (to celebrate success with HVs, and to showcase local service to stakeholders).
  • Focus on a systems approach to a long term workforce strategy, which can also be used as a tool to support new commissioners in their task, to help secure continued investment in the HV service. 

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