Health visitors

The Yellow Card Scheme, at first restricted to receive reports from doctors, dentists and coroners, has been gradually expanded to receive reports from other sources. From October 1996, the Scheme was extended to include reporting of suspected adverse reactions to unlicensed herbal remedies. In April 1997, the Yellow Card Scheme was further extended to include hospital pharmacists as recognised reporters of suspected ADRs. In addition, there are specially targeted extensions of the Scheme such as adverse reactions to HIV medicines and adverse reactions in children. Over the period, the Scheme has been gradually extended further to receive reports from community pharmacists and in October 2002, from nurses, midwives and health visitors. 

The approach taken by practitioners in dealing with parental drug problems as they impact on child welfare and child protection forms Chapter 9. The nine focus groups convened were each made up of three or four practitioners (n=35). The focus groups were split evenly between health visitors, drug workers and social workers (three groups of each discipline). 

The following health visitor was similarly attentive to the fine balance of interests in describing an approach to a mother whose drug problems were creating concerns for the wellbeing of a baby and also the older child ... 

Historically, the highest proportion of referrals to social work come from health visitors (Dingwall and Robinson 1993), which indicates both the breadth of their contact with families in the community and their watchfulness over the welfare of the child. The duality of their role as both supportive and monitoring, although not always comfortable, is part of a learned understanding of what it is to be a health visitor ... 

I was once at a conference where a male health visitor stood up and said we should be phoning all our clients in advance, after all we re not policemen and I was sitting thinking that s exactly why society have us because we do...we are proactive, we go out and we work with the... 

Drug workers and health visitors alike saw the advantages of not being seen in the same light as social workers by their client groups ... 

Two major sources of resentment were identifiable the first concerned the perception that social workers expected other practitioners to act as their eyes and ears and police their clients. The second concerned the potential treatment of a case once it had passed onto social work. Both issues connected intimately with their continued engagement with the adult client and/or children. The following health visitor provided a clear example of this ... 

We re supposed to work as part of a multi-disciplinary group and I think sometimes the social work department have unrealistic expectations as to what, or they don t know what the role of the health visitor is and just because they re not getting access they think that we can demand rights of access in to a home. And I, I feel as, I don t always necessarily get access into a home but if they come to me at the clinic, which some of them do, I content myself with that, that I m getting contact with the family and I don t want to break down the relationship that I have by demanding access into their home, I don t have any right to access, I m invited into their homes. 

The social workers in the focus groups confirmed this expectation that practitioners should monitor and report concerns to them, because of their statutory responsibilities to protect children. They acknowledged their limited access to families and reliance upon other practitioners, particularly health visitors, to keep a watching brief With regard to services offered by drug workers they could see the merits of a division of labour in working with parents and children ... 

Again this was couched in terms of the referring practitioner s concern to retain the relationship. Health visitors too found themselves in this situation they reported being asked, in particular by teachers, to refer welfare problems to the social work department. This dynamic was objected to on... 

A recurrently raised problem for the referring workers (whether drug workers or health visitors) was that in transferring the case to social work, there was the possibility of a different interpretation of how best to respond to the case. Most commonly for drug workers was uneasiness over a narrow focus on a child protection agenda. There was the expressed anxiety that the response might be overly coercive ... 

Children and family social work services in the UK are chronically understaffed the remaining staff are often demotivated and stressed by the volume of work, and the strain of working with difficult, frequently highly conflictual and chronic child protection cases. Many of the drug workers and health visitors expressed their sense of social work as a service in crisis, with extremely limited capacity to respond to anything other than the worst child protection cases, triggered usually by incidents rather than the chronic accumulation of problems ... 

Some time ago the international health organisations undertook a concerted campaign to eradicate smallpox. Most cases of the disease occurred in the third world and the front line troops for the campaign were health visitors. Each of these had a geographical area for which they were responsible. In order to motivate the health visitors a bonus scheme was introduced. 

Part XVIIB(i) - Nurse prescribes formulary for community practitioners (in Wales district nurses and health visitors)... 

Part IXB contains the nurse prescribing formulary (for community nurses and health visitors) and is similar in composition to Part XVIIB(i) of the Drug Tariff for England and Wales (see Section 2.4.1). 

There are three types of nurse prescribers community practitioner nurse prescribers (sometimes called district nurses or health visitors) who may prescribe from a restricted list of items, nurses who are supplementary prescribers (see Section 3.2.4) and nurses who are independent prescribers (see Section 3.2.5). 

Prior to 1994, only doctors, dentists and veterinary practitioners were allowed to prescribe medicinal products in the United Kingdom. That year the law was changed to enable district nurses, midwives and health visitors to prescribe from a limited formulary of dressings, appliances and some medicines. This formulary of medicines was extended in 2002. 

He needed to make a clay mould of the child s back so that the seat would support it properly. He was working in a multidisciplinary team together with a medical doctor, a physiotherapist and a health visitor. This illustrates very graphically that aerospace technologists are not only interested in complex esoteric technical problems. It can be far more enriching for them if they are allowed to relate their technology to real human and social problems [12]. ... 

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