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Health Visitors

I will turn to a number of other issues that my hon. Friend raised. He rightly makes an incredibly strong case for health visiting as a profession and for the distinct contribution that health visiting should and does make. We want it to make a more significant contribution in the future. It is true that, to some extent, health visiting is going through a difficult time in many parts of the country. The number of nurses in the NHS has increased by more than 85,000 since 1997 and the number working in the community has increased by 36 per cent. during that time. We can point to a significant overall increase in the number of health visitors. Undoubtedly, all too often, primary care trusts do not regard health visitors and the contribution that they make as being as powerful and important as it is. As it has not been given much publicity, my hon. Friend is probably not aware that my right hon. Friend the Secretary of State recently announced at the Amicus health visitors conference a fundamental review of the role of the health visitor in a modern society and health service. A big part of the outcome of that review will be the role for health visitors envisaged in these pilots. There are some difficult issues to resolve; for example, the nature of the universal service that is available to all parents and families from health visitors as opposed to more intensive, targeted support. As the Minister responsible I do not think that the nature of the service is clear. There is much work that needs to be done with the professional bodies, representative organisations and trade unions to tease that out. What is the minimum entitlement that every family has a right to expect from the health visiting service wherever they live? In addition, what is the offer? Will it be focused around the model and the partnerships outlined in the work of Professor Olds? We have to resolve that issue as part of the review. I reassure my hon. Friend and others that we understand that health visiting is at a crucial point. We need to look at the interface between health visiting and other professions. As completely different professions develop and emerge, we want to encourage much closer working relationships between people irrespective of their professional titles or job descriptions. We need to consider how to get maximum gain from health visitors, midwives, maternity support workers, mentors and the range of professionals who are out there trying to do their best to—as my hon. Friend described it—break the cycle of intergenerational deprivation. How do we bring all of that together in a maximum powerful way? In that context, we must recognise the distinct professional expertise and background that health visiting has to offer every community, and the review will be important in relation to that. My hon. Friend also asked about mainstreaming the resources and the comprehensive spending review. The Economic Secretary would not forgive me if I gave anything away, but he is absolutely right to say that we must plan ahead—his predecessor would have taken a similar view. The evidence is already there and if these pilots are successful, it would be a shame to have to wait four years before we can expand them. The guidance that we give to commissioners in the health service and local authorities is another vehicle by which we could insist over time that this cross-government outcome on early years prevention and intervention becomes one of their priorities. Therefore there are other levers available. My hon. Friend also asked about the caseload of health visitors. That is part of the review and the consideration in terms of a universal service as opposed to an intensive and targeted service. Clearly, the nature of the service determines what is a realistic caseload to take on to add true value and make a real difference, rather than having a superficial relationship with people that is not able to create the changes that we want. There are many exciting things happening: the pilot, the plan to deliver maternity choice, and the review of health visiting. We need to ensure that that all comes together and contributes towards the missing piece of the jigsaw in terms of early intervention. In the end, it is about breaking that cycle of intergenerational deprivation—