Health visitor workforce - shared learning


04 / 10 / 2012 2.54pm

To meet the government's vision for a new health visiting service and meet its local trajectory, Central Manchester University Hospitals NHS Foundation Trust developed a strategy that involved offering health visitor students employment on successful completion of their Specialist Community Public Health Nursing (SCPHN) qualification.

What we did and why

The birth rate in Manchester is increasing year-on-year and the health and well-being of children is generally worse than the England average. Currently over 40 per cent of children under the age of 16 in Manchester live in poverty.

Manchester required an increase of 71 whole time equivalent health visiting posts to meet its complex population needs. When attrition and turnover were taken into account this number equated to a need to train or recruit an additional 113 health visitors to address this gap.

Re-designing health visiting and early years services in Manchester was therefore identified as a priority by the Transforming Community Services Board, Manchester commissioners and the Manchester Children’s Board.

The trust developed a health visiting workforce strategy to support the delivery of the new health visiting service model. The opportunity to work with local authority partners to develop an integrated 'early years' service with health visiting at its heart was also developed.

In May 2011, a multi-agency task force, chaired by the trust’s director of nursing (children) was established to translate the call to action into a local plan. This was underpinned by six multi-agency working groups focusing on the safeguarding role of the health visitor, professional mobilisation, delivery of the Healthy Child Programme, pathways and partnerships, development of the assertive outreach role and outcomes and benefits realisation. Overarching information sharing work was also initiated.

How we did it

An initial analysis of existing health visiting workforce data was undertaken along with scoping of the regional recruitment position. A workforce strategy was then developed which focussed on two main areas:

  • recruitment of qualified health visitors, nurses and midwives wishing to train as health visitors
  • retention of the existing highly skilled workforce.

The initial analysis highlighted that recruitment of qualified health visitors was limited because of ongoing recruitment in neighbouring trusts. The trust explored the reasons that health visitors choose to work in Manchester and the reasons why they leave. A key reason for leaving was to take up posts closer to home. This indicated that retention could be improved by “growing” a local workforce of health visitors who were committed to working with Manchester families.

It was also evident that nurses and midwives were reluctant to leave permanent positions to undertake Specialist Community Public Health Nursing training if employment could not be offered upon completion of training. In response to this issue, the trust established a process to employ SCPHN students on permanent contracts through the implementation of a health visitor studentship agreement.

This model is undertaken through the usual recruitment process however the posts are advertised at band 5 and rise to band 6 upon successful completion of the course. If students do not successfully complete the course the trust has an agreed process in place where the individual would be offered to return to a band 5 position within the organisation.

Work has also been done with Manchester Metropolitan University to increase SCPHN commissions and a trajectory was set to recruit two cohorts per year over a three year period.

The health visiting team worked closely with the trust organisational development and training team to develop a comprehensive preceptorship programme to support the large numbers of newly qualified health visitors who will join the workforce.

To retain existing skilled health visitors, as well as develop new ones, the trust established a programme of engagement with the health visiting workforce. Every member of the team was engaged in development of the future vision and the health visiting team actively participated in the task force working groups.

The establishment was reviewed in liaison with commissioners and the proportion of band 7 posts was increased to recognise and maximise the skills within the workforce. New roles have been and continue to be developed to support health visitors develop special interests and act as a professional resource to colleagues. This includes the development of 25 practice teachers to support the SCPHN students.

A band 6 to 7 development programme is being developed to provide clear career pathways within the health visiting workforce.

From an early stage and throughout the development of the new health visiting model and associated workforce strategy, all key stakeholders including the trust’s executive team, commissioners, the children’s board, the Manchester safeguarding children board and partner agencies have been engaged, consulted and briefed on progress.

Results and next steps

The trust has successfully recruited high calibre staff to undertake the SCPHN course within Manchester and has offered students employment upon successful the completion of the course. Previous relevant nursing experience is acknowledged through placement on an appropriate incremental point.

The trust has also been able to recruit a number of experienced health visitors into newly developed band 7 roles, such as practice educators, therefore providing the required support for SCPHN students and enhancing the service with experienced and skilled health visitors.

The newly designed early years model will be phased in from April 2013, further enhancing the role of the health visitor.

The organisation

Central Manchester University Hospitals NHS Foundation Trust (CMFT) is the leading provider of community, secondary and tertiary healthcare services in Manchester.


Sue Ward, Director of Nursing (Children)  


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