Introduction

Karen A. Luker, Gretl A. McHugh and Rosamund M. Bryar

Our fourth edition of Health Visiting: Preparation for Practice is a key resource for health visitors, health visitor students, students on nursing, public health, early years, and health sciences programmes, and other health professionals working in public health, primary care, and community services. The practice of health visiting is focused on the promotion of health and the prevention of ill health. The fourth edition of Health Visiting: Preparation for Practice aims to inform, educate, and challenge you to deliver the most effective health visiting and so enable the promotion of health and prevention of ill health in the children, families, and communities with whom you work.

Prevention and public health have been the focus of health visiting since the early days of the sanitary visitors - the forerunners of health visitors - appointed by the Manchester and Salford Ladies Sanitary Reform Association in 1862. Since 1862, the living conditions, life expectancy, and health of the population have evolved, and alongside this there have been changes in the health challenges faced by the population. Over these more than 150 years, health visiting has responded to these changes by contributing to addressing public health issues from prevention of infectious diseases to prevention of long-term conditions; from addressing poverty and under-nutrition to working to reduce obesity in children and their parents. The aim of this edition of Health Visiting: Preparation for Practice is to provide you with the most up-to-date evidence to support your work on the front line of public health.

The fourth edition of this book is the latest in the line of works entitled Health Visiting which have aimed to support the delivery of health visiting. The first of these, Health Visiting: A Textbook for Health Visitor Students by Margaret McEwan, was first published in 1951. This was followed by three further editions, and, in 1977, by Health Visiting, edited by Grace M. Owen and written by Grace M. Owen and health visiting colleagues drawn from the health visiting programme at the Polytechnic of the South Bank (now London South Bank University). These books remind us of the changes in the preparation of health visitors during the past 60-plus years, but the statement by McEwan (1961: 17) of the purpose of health visiting is still the centre of today's practice: 'The health visitor is primarily a teacher and her aim is to teach the value of healthy living and to interpret the principles of health.' In addition, her observation that health visiting is: '.concerned with the little things of everyday life' (McEwan, 1961: 17) is also very pertinent. However, the evidence and knowledge base underpinning some of these 'little things of everyday life', such as weaning, play, and parenting, has grown enormously, as shown in the four editions of the present book. The first edition, by Karen Luker and Jean Orr, was published in 1985 and also entitled Health Visiting. The second edition followed in 1992 and was entitled Health Visiting: Towards Community Health Nursing, reflecting changes in the education of nurses and health visitors in the early 1990s. The third edition, edited by Karen Luker, Jean Orr, and Gretl McHugh, did not appear until 20 years later, in 2012, but the title, Health Visiting: A Rediscovery, shows the new confidence in health visiting and the role of health visitors in supporting families based on evidence concerning the importance of support for early child development and the need to reduce inequalities in health (Field, 2010; Marmot et al., 2010; Allen, 2011; Dartington Social Research Unit et al., 2015). The fourth edition, entitled Health Visiting: Preparation for Practice, builds on the third. It includes a new chapter on working with diverse communities, reflecting their multicultural make-up, and, critically, provides additional guidance on evaluation, enabling you to demonstrate the outcomes of your practice. What these books all illustrate are the ways that health visiting, over the past decades, has responded to and applied new and emerging evidence to support children, families, and communities to better promote their health.

Prevention, public health, and health visiting

Over the past 5 years, there has been investment into the education and employment of health visitors, with a subsequent increase in the number of health visitors, particularly in England and Scotland. Alongside this investment has been clarification of the health visiting service, with greater emphasis being placed on the public health role of health visitors working with children, their families, and communities. Health visitors have a long-standing role in helping communities to improve their health and well being; for example, in increasing immunisation uptake, preventing obesity, and tackling health inequalities. The Marmot Report, Fair Society, Healthy Lives (Marmot et al., 2010), sets out a framework for tackling the wider social determinants of health, stating that health inequalities will require action on:

• giving every child the best start in life;
• enabling all children, young people, and adults to maximise their capabilities and have control over their lives;
• creating fair employment and good work for all;
• ensuring a healthy standard of living for all;
• creating and developing healthy and sustainable places and communities;
• strengthening the role and impact of ill-health prevention.

Health visitors are the lead professionals for delivery of the Healthy Child Programme (DH, 2009; Public Health England, 2015), and therefore have a critical role in helping to improve the life chances of current and future generations by reducing the impact of inequalities on the immediate and long-term health of the population. Recognition of the important role that prevention has to play in improving health, and also in reducing health care costs, was identified in reports undertaken by Sir Derek Wanless in England and in Wales (Wanless, 2002; Project Team and Wanless, 2003) and reiterated for England in the NHS Five Year Forward View (DH, 2014a). In NHS Five Year Forward View: Time to Deliver (DH, 2015: 7), three gaps were identified: '.the health and wellbeing gap, the care and quality gap, and the funding and efficiency gap.' Health visitors have a key role in their work with children and their families in contributing to public health outcomes that address early on the health and well being gap. The six high-impact areas show where health visitors can have the greatest influence:[

• Transition to Parenthood and the Early Weeks
• Maternal Mental Health (Perinatal Depression)
• Breastfeeding (Initiation and Duration)
• Healthy Weight, Healthy Nutrition (to include Physical Activity)
• Managing Minor Illness and Reducing Accidents (Reducing Hospital Attendance/Admissions)
• Healthy Two Year Olds and School Readiness

(DH, 2014b)

Over the coming years, these areas for prevention will be the focus of health visiting services. From October 2015, local authorities took over from NHS England in the commissioning of public health services for children under 5 years (DH, 2014c). Currently, health visitors continue to be employed initially by the same employer, but service commissioning processes in coming years may see a range of new models of employment. The continued contribution of health visitors to the 0-5 years will remain key, but the greater integration of health and social care services (e.g. the Greater Manchester Health and Social Care Devolution (previously referred to as Devo Manc) project developments (Ham, 2015)) may present new opportunities, including wider integration of 0-19 services and the involvement of health visitors in population-based initiatives. In Northern Ireland, an integrated service for all children up to the age of 19 years is provided by health visitors and school nurses. There is an emphasis on working together, with a focus on delivery of child health promotion programmes and increased intensive home visiting for the 0-19 years (DHSSPS, 2010). In Wales, the recent nursing and midwifery strategy by Public Health Wales places nurses and midwives at the forefront of its public health strategy (Public Health Wales, 2014). In Scotland, in 2014, the government pledged to increase the number of health visitors by 500 over the next 4 years (The Scottish Government, 2014). Greater collaboration between services and practitioners (e.g. midwives and health visitors working with women in the antenatal period, social workers and health visitors working with families experiencing domestic violence or child safeguarding issues, school nurses and health visitors working to address obesity in 0-19 services) will be central to health visiting over the coming years. These additional resources and initiatives will assist with improving health visiting services. However, there remains a need to focus on measurable outcomes in order to evaluate these initiatives, which could lead to further changes and improvements in the methods of delivering health visiting services.

Health visiting: preparation for practice

The first and second editions of this book were pioneering in the quest for evidence to support practiceand in emphasising the need for evaluation of practice. Evidence-based practice and evaluation of impact now seem to be a given, and this...