Changing Role of the Health Visitors in the NHS

Abstract

Health care industry is now actively working towards enhancing the roles of health workers and is trying to create leaders out of these skilled personnel. The need for leaders among health visitors is a requirement of the future, and will ensure the progression of the profession of nursing to new levels. Nurses and health visitors are one of the most important contributors of the health care profession, and leaders from this genre will be able to provide unique and diverse perspectives on the health care issues, which will benefit NHS immensely.

Problems in the NHS Due to Lack of Guidance and Leadership

The current international health care systems suffer from many problems but they a stem around the fact that each has lived its life. In the current health care climate, these health care models are largely inadequate to meet the needs in face of the growing demands. The prospect of future health care industry is bleak without any proper reformation of health care structure. Till now, most of these health care sys have been largely working through trail and error, and have been facing challenges based on short term policy makings etc. These methods may have been helpful in the short term, but led to many negative outcomes on the system.

The result was the creation of continuous layers of bad policy over the other, which has created a very complicated system in health. NHS is no exception to these challenges, and with the passage of time, the leaders in health care are beginning to identify the need for better policies (Kvaerner et al, 1999).

Of the many issues that are affecting the NHS and the quality of its work, a very important issue is the lack of new and strong leadership. The NHS requires the integration of the new technological advancements with the old models that have stood the test of time. In this regard, the requirement of the future leaders is of those, who are able to understand the contributing role of the previous standards of healthcare model deliveries with the integration of new systems that will help advance future healthcare systems (McCormick and Wardrope, 2003, pp 72). NHS in the recent years has identified this need. Previously the leaders in health care were considered only to be physicians.

However, now, the need for leaders in all groups of health care is widely being appreciated as the best method of coalition between different health care sectors. A coalition of this kind will help in improving communications between the different members of the health care team. It will help in the relaying of relevant information and needs of the various groups of health care unit. And finally, it will ensure that the health sector is able to devise policies and various programs that are in accordance with and in harmony and synchronization with other health care sectors.

The NHS therefore, is now aiming to create a health care system that is more coordinated, more goal driven and is more feasible in all its aspects, medical as well as financial. The inclusion of other social sectors in this regard is among some of the initiatives taken to ensure that these goals are met with. But most importantly, it is the health leaders of the various disciplines who have taken the effort to initiate a structure that is oriented more towards quality care provision (Smith, 2003).

The NHS differs from many other health care systems of the world in respect of many of its principles and ideals. The first and foremost is the providence of care free of cost at the point of service. This is the fundamental right of every UK national regardless of race, ethnicity and socioeconomic status, and has helped in reducing inequity to minimal. The simple method does not include any co-payments structures displayed in the health care systems of America, which have been largely criticized to cause inequity among the masses (Light, 2003, pp 29 and 30).

Second is the provision of health care funds from the income taxes that the public pays. This increases compliance and trust among the public that their taxes are being used for the benefit of the community.

A very innovative idea included along side the above two implementations is the increased income of those GPs who work in the deprived areas (Light, 2003, pp 29 and 30). This helps reduce the socioeconomic barrier and creates interest among health workers to work in their own region instead of focusing on the big metropolitan cities alone. Along side inclusion of incentives and bonuses for healthcare workers achieving set targets introduces the fervor needed to give quality care. These and other such innovations have made the NHS one of the leading health care systems of the world, despite its problems (Light, 2003, pp 29 and 30).

The first and foremost problem with the NHS is the lack of proper funding to govern and run a potentially good and well-developed health care system. The NHS suffers from very basic issues, such as “run down hospitals, the chronic stages shortages of specialists in every field, the long waiting lists” (Light, 2003, pp 25) Even then, when comparing to well funded health care systems such as of the US, the NHS still ranks higher among the world’s best healthcare systems than the other. Why is this so? The main issue is the realization that a good health care system does not need a good funding unless it is applied with care and with methodology.

UK health care systems have understood the need and potential of the various preventive strategies and programs that can help reduce health care burdens in the first place, thereby reducing the need of spending in healthcare. This is not to say that the NHS does not require funding, far from it. It is only to state that the healthcare systems that are given a good and proper allocation in all aspects of health care have a better chance of success with more patient satisfaction that those where healthcare planning is inadequate (Light, 2003, pp 26).

But here is the crux of the problem. Unlike other industries that benefit with the presence of a good leader, the NHS does not have a leader in the first place. This lack of leadership can be stated as an essential cause of lack of effectiveness in the organization. Therefore, leadership is the first and foremost requirement of the future NHS (Smith, 2003, pp 326). Even if the NHS in this time gets hold of a very good leader, he or she will have a long way to go to revive and reform a system that is so long trodden and where change can even mean an upheaval of the entire system. The NHS therefore, is a very tough challenge to be taken up by any leader or set of leaders, and with improper funding and lack of proper support, any efforts and initiatives are very likely to fail.

It is not to say that the current health leaders should give up any efforts in the provision of care. On the contrary, the need for introduction of good reforms and policies is required more than ever, if one is to expect any future role or contribution of the NHS in UK. Since HS has been built on some very sound foundations of health care, it holds a fundamental position in the care delivery. The lack of maintenance in the past if rectified can lead to a new system that will be perhaps one of the best in the world. Only good leaders however are capable to making that happen.

The need for leadership is not only required in selected few individuals. This characteristic is a requirement that is needed in almost all individuals as the healthcare system grapples with the many new challenges of future medicine. There is a growing need for individuals who are able to carry out more tasks with proficiency and good skills. With losing numbers of people in the healthcare industry, and the rise of baby boomers’ elderly population, the challenges and stress placed on the upcoming health care professionals is also growing (Roy and Brunet, 2005, pp 422).

Along side, the lack of interest for opting health assisting professions, there is a growing shortage of such paramedical and technical staff, which can mean, an increased workload on those who are already engaged in the profession. With such problems, a leader has to have a total grasp and knowledge of the system of NHS and must have adequate skills and mastery in achieving these goals.

Since the NHS is made up of four independent organizations operating in England, Scotland, Wales and Northern Ireland. There is currently no one leader that these four organizations can look up to (Smith, 2003, pp 326). In this regard, there is a conflict of approach among these four sectors when planning policies and timing them. In this aspect, the need is to create a single governing body that the four sectors look up to and it should then create policies that are simultaneously functioning, thereby achieving the most effective results.

The role of health visitors in the NHS is a contribution that can never be forgotten. The NHS has been actively supporting the role of health visitors in context of providing distance healthcare services, and also in preventing many of the health complications and illnesses from advancing in the communities. In this regard, the NHS was able to prioritize the need for these visitors in different areas, such as more in deprived socioeconomic areas.

The prioritizing has helped in addressing many of the illnesses and problems of health that have high influence of socioeconomic status. With lack of information regarding proper healthcare provision, the health visitors may serve as a bridge to information to health (Billingham and Hall, 1998, pp 407). It can be easily stated that health workers have brought a new dimension to health care provision in non-clinical settings.

They have been able to up date and modernize their field very effectively; despite challenges, and technologies such as telehealth is a visible contribution in this regard. The active role of health visitors in various aspects of parenting, childcare and maternal health has improved significantly the quality of life manifold in the UK.

Current health visitors and nurses may be employed through various setups including private practice or general practice, but their recruitment and payments all are managed by primary care. In this regard, it is the primary care that is responsible for the decision-making process and policy making of the various issues of the health visitors and nursing staff (Derrett and Burke, 2006). With the inclusion and expansion of other health care alternatives, the roles of nurses have become more elaborated and organized into various categories and genres of specialties.

Now the UK health care system is working as the NHS and its various walk in centers, NHS direct, primary care trust medical services, and alternative medical provision resources etc. While on the one side, this means the evolutionary process of the current degrading health care system of the UK; it also means the emergence of new challenges within the system. Firstly are the adaptability challenges that many health care professionals are likely to feel, due to change in policies and consequent change in competencies (Derrett and Burke, 2006).

The second is the changes that the professionals may have due to changes in the work demands or requirements. Third are the changes in the new setups from the old ones and how to adapt to these new setups while maintaining competency levels and professionalism. Finally, the threatening effect is being anticipated among the nurses regarding their own future with regards to these changes in the healthcare system. Growing competition among the various health provider services is not helping the matters either (Derrett and Burke, 2006).

Recent threats to health visitors have directly resulted in the decrease of numbers of these health providers. With the reduction in numbers due to increased retirement age, growing competition and other such challenges, the health visitors are now taking exits from the field. This may be a counterproductive step for the UK health sector, which is already in need of additional health care workers.

The potential incentives of leadership and more direct roles in various health care decisions and undertakings can help retain these nurses and help encourage others to apply in the field as well. The past few decades of decreased importance given to nursing are the primary reason for the rapid decline of nurses. The current policies require that new nurses be given incentives to perform at more direct and influential levels rather than just taking orders.

In this regard nurse leaders are the best candidates to ensure such effects (Derrett and Burke, 2006, pp 1185). The same ageing nurses can then act as leaders due to their strong command over various health related issues and for their experience in the field. With proper training, these nurses will be able to provide more contribution to the health industry, and will help in creation of better structures and frameworks for the future health visitors.

The biggest contributor to the reduction of numbers of nurses is the lack of appreciation given to the nurses in the past. Nurses have not been given proper authority in the past, which has resulted in reduction in the number of nurses. Within ten years of 1984, the nurse population of the UK was reduced to half. Whatever the reasons, the main concern has been the lack of new nurses in the workforce. The unequal dissemination of tasks to the nurses has resulted in overstressed and tired nurses, who have lesser time for personal and professional development. In this way, nurses were left behind in the long run (Norton and Kamm, 2002, pp 331 and 334).

The current methods of introducing multidisciplinary teams have been largely successful, but it has only succeeded so far in retaining the nurses that were already present in the work force. There have been no significant improvements in the numbers of newly enrolled nurses, which is leading to acute shortages of nursing staffs not only in the UK but also worldwide. Previously, the nurses held no authority in the health plan of the patient and were not allowed to provide any suggestion in this regard. This alienated the nurses from the patients, although it was the nurses who spent the most time with the patients. The resultant lack of enthusiasm is the direct result of such discriminations.

Health visitors are no exception to these changing trends. The role of previous nursing leaders has been contributory in raising concerns and voice of the nurse community to the health care sector regarding their rights and their development. Now nursing is considered a separate discipline from medicine, with its own set of researches and studies. This has helped in improving nursing profession and has helped increased interest in the professionals. The need of the nursing leaders is to carry out more research based endeavors and carrying out methodologies that increase interest in the students in taking up this profession (Norton and Kamm, 2002, pp 331 and 332).

The leaders should first and foremost identify why professional decrease is taking place, and then find means to rectify them. In addition they should also try to find out the possible methods that can help improve the image of the profession and create general interest among the youngsters in making it a career choice for them. Other policies should be introduced regarding pay structure and work hours. Removal of discrimination and provision of equal opportunities for all segments of society should be of utmost importance to the health leaders.

These and many other such changes are creating a situation of watch and wait among the nurses, who are not willing to take up challenging roles or making voice of their opinions as to how these changes should take place. Many nurses may feel that they do not have the strong support they may require to make their demands heard (Derrett and Burke, 2006). The current health care system policies may be to blame, but the lack of leadership roles and initiatives in this regard are also matters that complicate the issue.

Therefore, the current nurse force feels the need for dynamic leadership in nursing profession, which is able to provide them with the sound voice and say over different issues of health care provision and the development of advanced systems of health care in the NHS (Derrett and Burke, 2006).

There are however certain benefits to the structure of the NHS. Since this is a nationally run program, it helps in the integration of all sectors of life and the community. Secondly, it is able to provide effective resources and finally it is effective in keeping the public informed (Davidson, 2003, pp 718). In the recent years, the NHS has increased its attention and priority towards the provision of quality care to the children. Whether acute or chronic or preventive medicine, the current NHS policies are working towards increasing the life expectancy as well as the quality of life of the children (Davidson, 2003, pp 720).

The health leaders therefore have a very good system to work with. This system is widely popular among the public. This system has been found to be effective in providing basic health care needs to all UK populations, without any form of discrimination. Therefore, the public is assured of equal provision of care and the equal provision of developments that will take place in the system. With regards to health visiting, the previous policies have worked very hard to provide equal level of care in remote areas of the UK. More effort if applied can result in a very efficient system of health care.

The following is an attempt to define the various qualities that define a leader. It aims to look at the leader in the specific frame of health and how health leaders are different from other type of leaders. The various roles of health visitors will also be discussed in order to understand their key contributions in the field of health. The article aims to identify the potential role of health visitors in becoming leaders in this area, and how these skills are honed into these fine individuals by their own practice. Health visitors acting as leaders will be able to provide substantial information about the health care needs of the community, and how they can be provided with best outcomes. The article therefore, is an attempt to explore the possible role health visitors can play as leaders in the health care industry.

The Definition of Leadership and Role in Context of Healthcare Sector

Following are few definitions of leadership

• “A leader is someone who can visualize a better world in the future and is able to convince others to join him or her on the journey” Deborah Allen. (Ten Questions About Leadership, nd, pp 1)
• “Leadership is the ability to guide and motivate a group of people to a common purpose” Bruce Bagley (Ten Questions About Leadership, nd, pp 1)
• “Leadership is defined by a series of behaviors. At the core are the belief that things can be better and the position to influence others to help. It is work, emotion, and inspiration. Central to success is having a realistic vision and the ability to share it with others who incorporate it as their own. Empowering others is the key to success and success furthers defines leadership” Marjorie Bowman (Ten Questions About Leadership, nd, pp 1).

This is essentially the definition of the leader in health care. Health care leaders delegate various responsibilities to others and ensure that the team moves and works together towards achieving common goals. With proper direction and motivation, the leaders are able to inspire confidence and are able to achieve the necessary targets of an organization. Leaders are groundbreakers, and are involved in creating new methods and policies that will provide better health to the public.

Identification of a good or a bad leader is a finding that may only take place in retrospect, but the main finding is the ability of these leaders to influence those around them. They are able to inspire the public or the team to carry out the desired goals with a clearer vision and more vigor. There are many factors that influence leadership, which may include “personal views and traits, personality behaviors, style, contingent situations, environmental or organizational culture and other variables” (Transcendent Leaders in Healthcare, nd, pp 1)

Of the many necessary requirements of a leader are some of the following. The leaders are flexible and adaptable in their approach, but are solid and determined in their goal and vision. Other qualities are wisdom and communication, integrity, positive attitude, desire, perseverance, insight, credibility, consistency, empathy and ability to listen to the needs of others. The leaders should be selfless and sympathetic in nature (Ten Questions About Leadership, nd, pp 13).

Health care leaders are required to handle two distinct responsibilities and areas of expertise. Firstly, they have to perform their moral obligation towards their health care duty and provide the necessary care and health service that is expected from them. Secondly, they are required to carry out various organizational services that they receive as a result of the leadership responsibilities given to them. This is a very difficult task and requires a lot of time, dedication, hard work and care competency to produce the desired effects.

Many of the clinicians and serious health care workers may prefer clinical work to their leadership roles, when they may be the best suitable candidates of the job. In this regard, the introduction of a leader, who is clinically skilled as well as possesses qualities of a good leader. Health care system therefore, suffers from the acute shortage of good leaders at the moment in all health areas (Transcendent Leaders in Healthcare, pp 6, nd).

It is essential to understand that a good leader cannot survive without the help of a good team. And therefore, the whole package of good care delivery resides in a good leader as well as a good team of subordinates (Bull, 1998, pp 124, 126). Whether it is primary care or any other form of care, the NHS requires the application of good teamwork and strategy to meet goals. In this regard, the leader is responsible to instituting responsibilities to the people, delegating authority as well as accountability, and the inclusion of all people of the team as equal members to the cause. The outcomes govern the policies and the strategies to be employed by the leaders (Bull, 1998, pp 124, 126)

The leaders in health care are required to provide clinical effectiveness in all areas of medical care. In this context, each health personnel are expected to practice the same him or her and ensure that he or she is able to deliver quality care to the public. Good competency levels are therefore, an essential requirement for both the leaders as well as the subordinates.

The leaders are expected to question the efficacy of the current clinical practices that are being employed in health care. The effective programs are those that are economical and are able to provide maximum positive results in the target population or group. The leaders should encourage the research based orientation in the selection of best methods for providing care, and should also look at the successful health care systems of the world, and how they have achieved their targets ((Achieving Effective Practice, NHS Executive, nd, pp 3).

Audits and discussions among care providers is another important way to understanding the trends of the health programs and what challenges can be faced by the health visitors. Research based approach is very likely to result in effective outcomes and will help in developing programs that are more future oriented in nature. The clinical effectiveness therefore follows the simple triad of inform, monitor and change. That is inform any discrepancies or deficiencies in the provision of care, change them to the expectations of the situation and finally to monitor the effects of these changes, and review if necessary. A continuously evolving health sector is the only method with which the health care system can progress. (Achieving Effective Practice, NHS Executive, nd, pp 4)

These methods are likely to result in multiple advantages for all the parties involved in health care circle. From the nursing perspective, they can expect evolution of their provision through recognition of good practices and discarding of the practices that are faulty or are no longer applicable. The constant evaluation role will help in creating a broad approach to the practice, which is the key requirement for the future nursing leaders.

The nurse leaders are required to give a new look and a new approach to the modern nursing practice and prevent the profession from falling into an old concept. Through strategic planning and constant help of researches analysis, the nursing leaders and especially health visitors can create programs that are of good benefit to the public being served. (Achieving Effective Practice, NHS Executive, nd, pp 7)

In this context, the challenges that the nurses in health visiting experience are many and continue to mount on the responsibilities already handed over. Study by Cameron and Christie in 2004 was aimed at identifying the problems that are faced by the health visitors in Scotland (Cameron and Christie, 2006). The study was able to shed light on many aspects. Cameron and Christie found out that the there is a lapse in the theoretical as well as practical approach in the health care delivery in public health and health visiting. The theoretical expectations are very different from the practical realities and problems faced by health visitors (Cameron and Christie, 2006).

With the advancement of the responsibilities, the health visitors claim they are facing various forms of “constraints” and setbacks in the adoption of new roles (Cameron and Christie, 2006). Firstly was the lack of recognition of the importance of public health sector in the overall health care delivery and the low priority given to this sector in the eyes of health care leaders. This limits any kind of developments in the area, which causes lack of application of any developments. In this regard, the healthcare personnel were not given any dominant role that could influence their condition. Lack of infrastructure is also influencing the quality of work of the health visitors (Cameron and Christie, 2006).

This research is a mirror of the kind of problems that health visitors are facing all across the Europe, and how it will affect the outcomes in this regard. Health visiting is a profession that is faced with many problems and its survival depends on the health leaders, who will sustain the quality that is necessary for the future (Cameron and Christie, 2006).

Leaders in health visiting are now a necessity rather than a requirement. There is an increase in the awareness in this regard, however, sadly, the progress in this area is still very slow. The lack of education that is specifically related to development of leaders in health visitors is the primary setback in the progression of this field. Leaders should be made in order to ensure that some kind of progression should take place in this area.

The Traditional Roles of the Health Visitors and Why They Are Important in the NHS

The role of the health visitors is evolutionary in nature and images the changes that have taken place in the NHS during the years. Their roles have been very essential in the healthcare system, and they have been primarily appreciated for identifying the needs of the community regarding health.

These needs are recognized by various epidemiological methods of screening, vaccinations and testing, surveys etc. Via this method, the healthcare visitors are able to identify the chief problems of the residents in the area, and the trends in health being seen during the years. Since it is these people who are involved in the integration of new programs in the communities, they are directly able to identify shortcomings, advantages and disadvantages of various programs, and how they can be made better (Billingham and Hall, 1998, pp 406).

The role of health visitors is very easily understood by looking at the primary reason of the health visitors. Health visitors are engaged to provide universal health care to the region they are working in. This aim is enough to understand the primary reason of health visitors. While hospitals and primary care clinics are made to provide health care needs to illnesses that have taken place already in the patient, the health visitors are involved in reducing the income of such patients by preventing new cases from occurring. Good information regarding various health issues and methods of preventing them can help in reducing these incidences. This is the prime work of the health care visitor, and is the definition of provision of universal health care, despite the location or other ethnic or otherwise differences.

Health visiting is a profession that is original of the UK health care system. This system is based on the amalgamation of both universalism and public health approach. This is perhaps one of the most effective methods of bringing health to the public. Although this profession started out in a very positive manner, various policy complications and faulty issues have affected its role in the recent years. Now the health visitors have many problems and complications along with the challenge to provide up to date and more competent health care service. With passage of time the demands on the profession increased with no leeway or advantages given to the workers. Therefore, now, health visitors are facing many problems that were not evident before (Lowe, 2007, pp 20)

Realizing the importance of health visitors and their cause is the key determinant of the success of the health care system of various countries. Countries such as America have still a long way to go in realizing the role of health visitors and the potentially contributing role they can play in reducing various forms of illnesses (Light, 2003, pp 27).

The shortages of nurses are likely to remain if the current health care systems continue to work with the same management styles. Whether they are rich or poor countries, most of the health care systems are turning obsolete and health care sector advances and expands. Without the addition of good leaders and workers, the current health care crises cannot be avoided. These and many other such similar issues are the new goals of the future leaders.

The leaders should now consider achieving positive health care outcomes and creating situations that ensure it and promote research cultures. These integrations should be carried out in all levels, and should be applied nationally as well as on the local level. Proper training and education in all aspects should be carried out in rural areas as well; to ensure that equal benefits are provided to all (Neil, 2008, np).

Identifying the good leaders in health visitors requires an in depth understanding of the key issues that are faced by an individual health visitor, and how it can effect the competency levels of the person. One of the chief questions that usually arise is whether health visitor’s role has become old fashioned due to lack of up dates carried out in this regard. This may seem impossible at face, but the recent trend of reduced nursing enrolments than before do show that with time, nursing is not such a popular choice for profession as it was in the past. Faced with such primary challenges, the future health visitors becoming leaders will have to think of original and creative ideas to ensure provision of quality nurses (Lowe, 2007, pp 5, 7 and 10).

Health visiting is not so an old fashioned profession as was before, since with the advancement in the health care, there has been an advancement in the preventive care medicine, which is an essential feature of health visiting. With the advent of more technical gadgets and methods of communication, health visiting is now faster than ever, and medical aids can be given with more ease and with more frequency. This is the primary method with which health visiting can progress at a faster rate and with better results.

Health visiting therefore cannot by made obsolete due to lack of developments in the area. Because without health visiting, a majority of the UK population will be deprived of the basic necessity of health care delivery and access. This will contrast with the primary requirement of provision of health care to all as laid down by the health departments in the UK.

How Health Visitors Can Be Better Leaders Than Outsiders

“Some are born great, some achieve greatness and some have greatness thrust upon them”. (Shakespeare, Twelfth Night, 158)

Health visitors are involved in a myriad of cases that affect the community and therefore, they are involved in the overall health care provision and care of the area. The population span therefore ranges in all age groups and affects all areas disregarding race, religion or creed. In the children for example, the health care visitors are involved in the prevention and treatment of postnatal depression among women. They are involved in the provision of care and advice of mothers for children’s health and immunization needs, and help in preventing cases of sudden infant death syndrome and home accidents. Other areas under health visitor’s domain include reporting incidents of child abuse, and caring for the parents suffering from depression etc. (Billingham and Hall, 1998, pp 406).

This makes health visiting a challenging profession to engage in, since it requires expertise in care of all ages, both sexes and all socioeconomic levels. A health visitor therefore, should be shrewd enough to recognize the potential health problems that may pertain to a certain group of individuals, and identify other social factors, which may have a strong bearing on the health condition of the patient.

The competency levels and the potential role of leaders in these health visitors have been displayed many times in the past. Since the health visitors are involved in the demographical collection of information and data, they are capable of linking various incidences and coincidences. Nursing theories are largely based on the method of reasoning and deduction. Most of these hypotheses have stood the test of time, since they are based on sound medical records and information (Barker, 2003, pp 1428 and 29).

For example, the role of health visitors in establishing the connection between fetal and child health and the future possibilities of illnesses is maintained as one of the best achievements of health visitors. Leaders such as Ethel Margaret Burnside are among the many nurse leaders who based the foundation of research in nursing. Her research in the correlation between infant health and their potential development of future illnesses was a dramatic shift in the level of care provision in community service. These and other such initiatives are the backbone of future community health work and the need for more leaders to take up such challenges is required more than ever (Barker, 2003, pp 1428).

The health visitors are more likely to identify any discrepancies that are found in the health care system depending on the location and the area. Since most of the policies are made for the local sector the culminate effect is lost and the overall improvement remains unachievable. They also realize that community efforts do not bear results immediately, and therefore, long term planning is essential to make these efforts successful.

Health care can be key representatives to the managements in achieving such goals and in advising the proper mode of action required to achieve desired results. With the help of demographic information as well as past experiences, the health visitors are more likely to devise plans and techniques that will provide swift and better outcomes for the community (Neil, 2008, np).

This establishes that the future health care leaders should also be proficient in human resource management in line with the current challenge of reduced numbers of health professionals (Neil, 2008, np).

Currently the health visitor leaders are to tackle four main issues in nursing area. Firstly is the modification of the nurse workforce that is highly competent and flexible. Second is to provide these professionals with the tools to ensure their professional development and continuing education. Third is the creation of nursing leaders who can take up the future challenges pertaining to nursing? And finally, the modification of the nursing career that is in line with the demands of the evolving health care system (Lowe, 2007, pp 15 and 18).

Since community medicine and public health are areas that are very strongly influenced by demographic and trends, the health visitors are required to be more observant of the changes and are required to possess capabilities to identify what trends are about to take place. In this regard, now health visitors and their leaders should be able to harness all sources of information for their constant development and should be well informed of both local and global trends in health care.

Clinical effectiveness with research methodology is also required to ensure positive outcomes. The regional, cultural, economical and national requirements of the areas should also be held on to and health leaders are key players in ascertaining that there will be no discrimination in the provision of care to anyone ((Achieving Effective Practice, NHS Executive, nd, pp 16).

How These Leaders Are Made, Skills of Leaders and Their Training and Development

Almost all health care professionals are involved progress by continuing education or by continuing professional development. These continuous pursuits not only improve the competency levels of the health care professional, but also inspire and encourage these personnel to take up more challenging roles and tasks. This therefore helps in the promotion of the health care community, and the introduction of new individuals creates new ideas.

The progressive development in the line of work while on the one side creates more competent individuals; it also leads to creation of the new visionaries that will maintain the health care sector of the future. Leaders not only introduce new concepts in health, but also identify any disparities and faults that are present in the health care system, and produce ideas to alleviate these faults (Pringle, 2000, pp 738 and 740).

Nursing leaders are essentially keen observers of the environment that they work in. as leaders they are required to identify and assess very small as well as large pieces of information and then decide which is of relevance to the professionals. Therefore, research becomes a key tool for the future leader, who must maintain good information and understanding of the developing trends in health care. Learning through other health care structures and by comparing them is also a very healthy manner of developing one’s own system. Research is now literature as well as practice and each is dependant on the other for its development. Therefore, literature as well as practice is the future methodologies in public health and nursing (Achieving Effective Practice, NHS Executive, nd, pp 18)

Health visitors are now involved in a variety of programs on various community levels. At community levels, they are involved in creating health needs assessment programs, involved in PCT liaisons, interagency local planning, and in evaluations. In community development, the health visitors are involved in community-based groups, providing health information to communities, and in laid workers projects. In-group work, the health visitors are involved parent support groups, smoking cessation therapies, antenatal groups, health education groups and in self help groups. In health prevention and promotion programs, such as family health plans, information collection, health education, support regarding behavior change, immunizations and screening.

This is a very broad range of functions requiring different skills and task management. Health leaders therefore have now to create a new line of health visitors who are able to manage each task with equal proficiency. Although the new role of NHS is leading to creation of specialties in the health visitors themselves, they must however, be proficient in handling all issues pertaining to the requirements of community and public health. (Transcendent Leaders in Healthcare, pp 14, nd)

It is essential to know that leadership is not an easy task that is manageable by each person. There can be many barriers that may lead to failure of developing leaders. Firstly, the persons may be lacking in the ability to visualize their goals and this may prevent them from achieving their necessary goals. Most of the people may possess the necessary qualities, but may think that they are not the perfect people for the job. Lack of energy or courage is also a very likely reason for lack of leaders. These and many such barriers are the main reason why there is lack of leaders in the health care sector. In order to crate better leaders in healthcare, the current leaders need to develop the necessary skills in their team members that allow them to take up future leader roles. (Ten Questions About Leadership, nd, pp 17)

In the health care sector, another main problem is the lack of proper training programs that create better leaders. This leads to a decrease in the confidence among the health care professionals to take up the necessary leadership burden. Therefore, the health care leaders must include necessary programs and workshops that help create leadership qualities in the staff. Alongside, by delegating responsibilities to the junior staff, the seniors will be able to carry out more functions, as well as continue training of future responsible personnel in leadership.

The proper environment, which supports the role of responsibility and efficiency, is the primary playground for the nourishing of the leaders. While necessary academic qualifications are an essential part of the leadership in health care, the clinical performance and experience is also a very important factor in the delegation of a health leader.

Qualifying for Leadership Among Health Visitors

The various surveys and time-tested findings have shown that NHS leaders should show some particular traits that may be different from leaders required in other organizations. The empathetic nature is the most critical requirement of the NHS leaders, who have strong communication skills. This is essential since healthcare sector includes all aspects of life and people, who require various forms of emotional support (McCormick and Wardrope, 2003, pp 73).

The employees of the healthcare system also belong to different levels, which must be addressed on the one to one levels. These leaders must be able to delegate authority on to others as well to attain good operation of the various health departments without problems. Such leaders must be especially approachable to any one, and everyone, and he or she must be able to understand and respond to the various cultural and ethnic variations that hospitals may come across with. Since healthcare is a constantly evolving field, the identification of the need for research and development is essential and the leader should be able to provide with good resources to attain these goals (McCormick and Wardrope, 2003, pp 74).

However, this is just one facet of the leader that is required in any healthcare system. A particular system of health is nevertheless a system that is run in a society; therefore, money, expenses, budgets, funding and various social services also play an essential role in the overall running of the hospital. In this regard, the healthcare leader is required to have strong managerial and business skill as well, who is able to allocate resources, staff, personnel, equipment and funding appropriately to all departments. Such a leader should be able to assess the various policies of the government and be able voice judgment and advice that will benefit the health care system and the public (McCormick and Wardrope, 2003, pp 72).

The public is the most critical part of the health care system. Patients and their attendants require the provision of good services by the healthcare professionals which are up to date, economical, efficient and speedy, and which are carried out with care and empathetic behavior. The patients therefore, should be the primary priority in the healthcare system, and policies should be framed accordingly (McCormick and Wardrope, 2003, pp 72).

Leaders should be critical as well as open in the various ideas that are presented to them. Again the proper identification and assimilation of knowledge is the core requirement of a leader, who can only then devise successful policies and plans. Criticizing is a very important factor that is required in a leader, who can then determine the faults and the benefits of a system and how to achieve the best without suffering from the worst. By practical as well as theoretical knowledge and assessment, a leader can reach many concepts and can then utilize it according to the particular needs of his or her own system of health care (Achieving Effective Practice, NHS Executive, nd, pp 26).

Requirements of the health visitors are no different as are for leaders. Therefore, health visitors can be said to possess the necessary leadership qualities that are required in health care. The leaders in health therefore, are those who set new goals in the health care, and try to create new ways that are more rewarding in their prospects. The leaders are therefore, required to mobilize the resources and mobilize the enthusiasm and spirit of others to achieve mutual goals. The leaders are able to create professionals from any one they choose to work with. The leaders are able to inspire confidence and courage in their teams to achieve their goals. These and many of other such traits are the qualities that are present in the healthcare workers. (Transcendent Leaders in Healthcare, pp 42, nd)

The main issue with leadership is the lack of identification of factors that make leaders. Depending upon the situation and the location, the leaders’ qualities are different. The leader is therefore a mixture of various attributes that best cater to the need of the system, which requires organization. The leaders therefore, can belong to any class and any social background and may possess a mixture of characteristics within them (McCormick and Wardrope, 2003, pp 73).

Teams and Leadership

Health visitors have shown marked improvement of quality of life in the communities that they have worked in. health visiting programs carried out in any of the areas, even outside of Britain have shown a significant difference in the improvement of quality of life attained. The study of Elkan et al in his UK based study in 2000 has shown this in a very convincing manner. These interventions have shown improvement in the overall health of the children, as well as the parents. Results from the study showed that there were following positive responses seen as a direct result of health visiting

• Improvement of parenting skills as well as improvements in the home environment
• Improvement in the various child behavioral problems
• Improved development of the children, despite the factors such as low birth weight etc.
• Reduction in the incidence of home accidents
• Timely and accurate detection of postnatal depression
• Improved social support to mothers
• Improved breast feeding rates (Elkan et al, 2000, np).

The same study was able to demonstrate a reduction of mortality of the elderly population, due to timely visits and care and was able to reduce the length and numbers of visits that these patients had in hospital settings. In this regard, these visits were found to be more effective as well as economical (Elkan et al, 2000, np). Leaders play an important role in determining success or failure of a particular task undertaken. Without proper guidance or guide map, any good plan will fail. With proper planning and guidance, Elkan et al, was able to show that health visiting can improve its access as well as its level of care provision.

Leaders are also required to carry out audits at regular intervals. Audits in clinical practices are excellent tools in finding out the efficacy of the particular program or system and how much benefit it is giving as compared to other contenders. Nurse leaders and especially health visitors can apply audits to identify how successful or unsuccessful their campaigns of health have been. Since much of the work in public health is also related to campaigns and public information, these programs can also provide for checks to see the cost effectiveness of the programs and whether certain policies were successful or not.

Auditing is a process that can be carried out by many health professional, and in doing so, he or she can make a positive contribution in ascertaining which methods are best for particular issues. The audit is among the primary tools that help shape future policies related to health. These audits are able to look into the various factors that may be playing a role in providing particular health service and help in modifying them for the best (Achieving Effective Practice, NHS Executive, nd, pp 35).

Leaders now have to realize the important community role that nurses play in health care, and how it affects the level of health care given to such individuals. Health visitors are no longer just nurses coming on regular visits. They have created a new level of care, which has gained confidence and trust of the people around them. For example, now health workers are an integrated part of the families with which they work in, and are involved in the caring of the entire families according to their needs.

This integration has been achieved through hard work, and future health leaders are to ensure that such relationship between the two parties remains. Nurse leaders now have to realize the important role that health visitors have to play in providing constant service to the community at all times.

In this regard, meeting the personal and family needs of the health visitors is another area that they must address. Prevention of overwork, stress, lack of quality of life and tiredness are some of the common problems seen in overworked health workers. The leaders of the future must ensure that such problems do not take place, so that health visitors are better able to enjoy their jobs and lives, and be able to give undivided attention to their profession (Making a Difference, 1999,pp 6) Health leaders must ensure that health visitors are given due appreciation for their services and various incentives and bonuses should also be placed to ensure a positive outlook among the health visitors.

Women and Leadership

The role of women in the leadership role has still not been established to full scale. There are many reasons for this lack of information, and these are to be discussed in detail. The main problem seen however, is the lack of women or a very small proportion of women in various leadership roles. While this trend is found in many professional fields, the topic discussed here is in reference to medical field (Kvaerner et al, pp 91).

The attempts to improve healthcare leadership of women in various countries are underway, but still there are many hurdles to be overcome. The Norwegian healthcare system for example, has provided many incentives and benefits to women to improve their working conditions with out interfering with their various family and social requirements (Kvaerner et al, pp 91, 92). These improvements have lead to a more equalized status of benefits to both male and female healthcare providers.

However, some areas still remain to be overcome. The study carried out in this regard concluded that men have more chances of gaining leadership positions than women, with less representation of women in higher positions of healthcare. It was also found that those fields of medicine where women are more prevalent than men show higher incidence of women leaders (Kvaerner et al, pp 91, 93).

The primary complication in the health visitor development programs is the dichotomous nature of environment that they are being applied. The new programs related to health visitors are looking into the future requirements and how these need to be addressed and implemented. Although this strategy is excellent, it is being placed in the structure that is very old, and is now becoming faulty due to lack of development in this regard. Merging new in the old is very difficult to achieve, and therefore, successful implementation is rather hard. Similar old structures are causing complications for women health visitors, who have to fulfill many other obligations besides work.

Without proper support to these workers, who constitute a major bulk of the health visiting staff, the outcomes are not likely to be successful. The health leaders of the future therefore must identify the needs of the health visitors and allocate times and duties that enable them to function more efficiently (Making a Difference, 1999, pp 9). Female health visitors are also part of the community, and many of them may be living in the single parent system.

This can make it very difficult for such health visitors to provide good care to the patients as well as to fulfill their roles in their own personal lives. Health leaders therefore, now have to start considering health visitors as not only professionals, but also as people, and therefore, provide help to them. Ethnic minorities have been a very small fragment of the contributing force in health visitors, and these need to be included in the mainstream. (Making a Difference, 1999, pp 10)

By communizing the telehealth system that has been so successfully applied in the UK system of health, the health leaders can expect to achieve more work with less movement. It will let the fingers do the talking, and will allow the health visitors to spend less time in running around and be able to provide care to more patients. Contacts via help lines; Internet, telehealth etc. are now the new trends in the health visiting teams, which are likely to speed up provision of health to the patients. This also helps in improving patient satisfaction, and allows confidence in the patients that they are being cared for 24/7. (Making a Difference, 1999, pp 11)

Hvs and Pct

The current strategy of the NHS has shifted its focus towards giving nurses more autonomy and providing them more direct roles in the provision and planning of care of the community. Previous attempts largely failed to produce significant results due to lack of autonomy of the nurses. With a more direct and in charge role of the nurses, it is expected that the outcomes achieved will be more significant than those achieved in the past (DoH, CNO Bulletin, 2005).

Therefore the first and foremost attempt has been a nurse led community cares system that is run by the nurses in planning and implementing. Since nurses are more involved and experienced in caring outside of the clinical practices of primary care, they are more receptive towards the needs of the community and the trends that may be taking place therein (DoH, CNO Bulletin, 2005). Therefore giving more autonomy in this regard will result in better planning and implementations of various programs, increased vigor and interest among the nursing staff, and the consequent better achievement of goals.

Introducing grants for nurses is also another important endeavor by the NHS, in hopes that nurses will take on a more active role in the provision of care than in the past. With more authority over various matters of health and prescription, nurses will be able to provide a level of extraordinary care which is independent from major health care settings, and which will help in improving the overall quality of life of the people living in the community. Removing ethnic bias and promoting teamwork is considered to help in improving these outcomes as well (DoH, CNO Bulletin, 2005).

The inclusion and consequent integration of the nursing in to the primary health care sector should have been carried out a long time ago, but only begun to take its effect in the recent years. The nurses’ roles are to increase with time, as well as their say and authority in the provision of care in health sector (Beech, 2001, np). The new nursing teams are a mixture of leaders and novices, who will work in accordance with each other and with other health professionals to provide a new level of health care previously missing from the NHS. The concept of inter professionalism is finally taking place. These teams are expected to provide a new research ground for nurses, where they can achieve good outcomes (Beech, 2001, np).

The Department of Health has very efficiently described current nursing challenges as a broad mixture of social, medical, ethical, and financial challenges that each has a significant role to play in the future of the profession. With more responsibilities now being handled by nursing professionals, the future leaders have to look closely at the various government policies outlined for these professionals, creation of more evidence related programs that give the deserved time for successful completion, universalism in the provision of care and service, identification of future health trends and ways to address them.

Also areas to consider are the inequality in health care provision, changes in the family structures, and changes in the perceptions and demands of the public that the health visitors wish to serve. The role of changing cultural demands is a very important ethical and social context that is required from the future nurses. These and many such challenges are some of the key issues of nursing and nurse visitors, which require proper addressing in order to make the profession sustainable in the future (Lowe, 2007, pp 17).

Health Visitors as Leaders of Multidisciplinary Teams in the Community

The modern NHS is the amalgamation of three main areas of healthcare provision. These include the provision of primary healthcare with community healthcare as well as the social services. Previously, these three areas were working towards the same goals but with different paces and programming. The current NHS goals have modified these roles to take place in coordination with the other, so that each service is able to achieve more with the aid of other.

This system is however, not limited to the NHS alone. Almost all of the dominant and developed healthcare systems of Europe have learned from the advantages of the NHS technique and are currently implementing as well as experimenting with these reforms. This is the true crux of health care provision, which was known much long ago, but was implemented only recently. This is the key reason why European healthcare systems are dominating over the American healthcare system, which is among the most advanced healthcare systems of the world (Light, 2003, pp 27).

Here is where a main concern for NHS leaders lays in. many leaders feel that there is insufficient methodology and curriculum that is included during the training of the health visitors that is required by them. Additionally there has been an increase in the number of roles that have been expected by the health visitors. Therefore, health leaders now have to work towards creating programs that cater to these changing roles, and help in building competency levels of these personnel.

Secondly, as the need for more integrated community roles develops, the integration of community-oriented information is also a requirement. Finally there is a need to develop more research-oriented mind frames of the health individuals in order to promote high quality of health care in the community (pp 16). The removal of grading system is also a need rather than a possibility for future health care progression.

The current concept of part time health care visitors is now a very common concept. This may be due to many reasons. The workers may be involved in family issues and may have to devote time to their children and family needs. He or she may be planning further education and may be taking up programs of continuing educational development. These and many other such reasons require that there be an inclusion of these considerations and help be provided in the programs to ensure overall development of the health visitor. The leaders in this regard can help make outlines of various programs and time frames that can help in better organization. (Making a Difference, 1999,pp 17)

New proposals have now created more advanced career frameworks for the health visitors, and now the discrimination that could take place due to health designation will start to reduce with time. Now health care assistants can up grade to levels registered practitioners, senior registered practitioners and finally consultant practitioners. The extended and modified roles can help in the advancement of medical careers that had in the past suffered from rigid frameworks (Making a Difference, 1999, pp 34).

Various Potential Roles of Health Visitors

Health visitors are able to perceive many of the issues that pertain not only to health problems per se, but are able to identify the various social issues that may contribute towards health provision. The issue of inequity is a very important issue that has risen during the past few years. The health visitors in this regard hold the capacity to identify any areas or people who may not be receiving their fair share of health care (Perry et al, 2007, pp 6).

Therefore, health visitors are not only responsible to provide the basic necessities of healthcare to the public, but also ensure that proper quality of care is also given. In this regard, the role of a health visitor is to plan and undertake programs that provide better quality of health care. In this regard, a leadership role of the health visitors can be a very beneficial step in ensuring this quality provision. Since inequity can be based on race, sex, ethnicity, and socioeconomic status, the health visitors can ensure quality health care provision by eliminating such differences (Perry et al, 2007, pp 7).

Case in point is the efforts placed by the HAS in Haiti, who have carried out extensive treatment programs for patients suffering from tuberculosis. Of the total of 400 patients that were enrolled in the treatment plan of tuberculosis, only 7% of the patients were not compliant with their treatment plan (Perry et al, 2007, pp 7). Tuberculosis is a disease that is highly prevalent in the lower socioeconomic status, and such patients are mostly not able to afford their medicines or follow their prescriptions with timing.

In this regard, the ability of the health care visitors to ensure proper compliance with the tuberculosis treatment regime, which is usually a very long-term treatment, is a significant achievement. HAS in the recent years has been actively involved in providing equal quality services to people despite their geographical locations. These and many efforts although may be due to the policies of the government, but it is the collective effort of the health visitors too that has enabled such initiatives to take place (Perry et al, 2007, pp 6).

Elkan et al (2000) also claims that health visiting is only part of the total package that will ensure complete social and health development of the community. Although the number of visits and access to health visitors is a very important factor in improving health outcomes, it is necessary to understand that this is not the only mode which can bring “radical changes in the health care system” (Elkan et al, 2000,np) Therefore, what is important is to realize its place in the health care industry and develop other sectors to the extent that will support and benefit the role played by the health visitors (Elkan et al, 2000, np).

Another potential role that health workers and leaders can play is the creation of programs and efforts that will promote unification of the diverse health care system through unification and cooperation. These reforms are however, not limited to health care outcomes only but also would require reforms related to financing, equities and policy making in order to reach their full effect. Reforms help in increasing morale of the workers, and incentives such as bonuses etc. provide a very positive initiative for good working. These reforms are an essential requirement of almost all health care systems of the world, which aim to remain in the future. The health visitors are more likely to provide the necessary informative structure that will ensure success of the future health care systems.

As stated by Ssengooba et al (2007)

“ Health workers are key stakeholders in any reform process and should participate at all stages, that is, conceptualization, design and implementation. Reforms tend to create losers and winners or can change power structures but it is important, at the least, that winners and losers understand the purpose of change and have confidence in the process of consultations on which change has been determined” (Ssengooba et al, 2007, np).

Health Visitors’ Role in Child Health

Child health is a very important target for health care visitors programs, and many of the programs are specifically designed to address the health needs of mother and child. These public health interventions in all its forms have been recognized to provide the maximum impact to good health of the child as well as the mother, and have improved health care outcomes significantly. With new concepts and technological advancements, the leaders of nursing profession have to update and modify health visitors so that they provide the maximum of benefits to the public via good information tools.

One role that the health visitors play is the provision of information and knowledge to the parents who start their phase of rearing children. Many of the children suffer from various household accidents that are preventable in nature (Geilen et al, 2002, pp 40, 41).

Most of the parents are unaware of the simple measures that can be taken to avoid these morbidities. Health visitors, by visiting homes and providing essential information to the parents, can help in educating parents about emergency managements and methods to prevent such catastrophes (Geilen et al, 2002, pp 37). Therefore, home safety visits are another strong initiative provided by the health visitors with good success rates. Researches carried out in this regard support the reduction of numbers of accidents and incidences when health visitors’ interventions take place. These interventions are carried out outside of the hospitals and primary care clinics etc.

This is a good strategy in the sense that the number of visits carried out to the hospitals or healthcare centers may be limited as well as specific to the particular need of the time. This may limit the amount of time that a health care provider may give to the person regarding various preventive or health care techniques. At home services in this regard, are very helpful in providing each client with the amount of time that they need and in addressing their particular health care problem, as well as preventing any accidents or incidences before they take place (Geilen et al, 2002, pp 35).

Leaders are now implementing time framed programs for parents both before and after birth to train and inform them about the various issues that are related to parenting, care of small children, noticing any health problems that may be taking place in the child. Leaders also are now training health visitors to help families deal with their family issues in more positive manner, which can prevent development of faulty personalities of children. Leaders however, need to motivate the visitors not to give up on cases that seem difficult or impossible to carry out, and should review and assess these programs time after time to ensure their productivity.

It is now well appreciated that the health visitors have played a key role in advocating-g the rights of child health and in improving the quality of care to the children. In this regard, the NHS in the past had faulty planning and policies that made it difficult for many of the patients to reach or acquire health care. Health visitors were the first to rise concern about the identification of the “needy children” that is those children who would require healthy nurturing to maintain their health. More efforts have resulted in the creation of laws for providing health care to children (Davidson, 2003, pp 718).

By giving more rights to the workers, the health leaders have now achieved a more direct role in the care of the child, instead of acting as an advisor only. The health leaders are now teaching the visitors the various ethical, moral and legal implications of various types of neglect and abuse and how they can provide such children with the help they need. With more coordination between the government and other agencies, the health visitors can now ensure a very positive future for those children who suffer in disruptive conditions. The health leaders however, must also educate the health visitors from protecting themselves as well, and not to carry out any action that can lead to liability or legal action. With the issuance of more policies these areas are likely to get more coverage than ever before.

The current requirements from health care visitors are the provision of good care and preventive health to children and prevent any form of exclusion in this regard. Along side is the handling of issues such as obesity etc. and ensuring good mental and psychological health of the children. In this regard, the health visitors are required to help parents in taking proper care of the children and providing them with their appropriate needs.

These issues include exercise and eating patterns of children, identifying any type of substance abuse among children, identifying educational challenges and how to manage them at child level, identifying delinquency among teenagers, identifying teenage pregnancy issues, smoking and mental psychological problems and managing them respectively. (Lowe, 2007, pp 20)

With the rise of psychological ailments and violent behavior expressions, the health leaders now have to tackle and identify issues such as tension, mania, depression, anxiety and phobias etc. along with other forms of psychological problems. These psychological problems in children present themselves in different forms than in adults, and their changes in the normal behavior are often very suggestive. Therefore, now health leaders are training health visitors to identify such psychosocial problems among children as well and to report them and institute proper medical attention. In many of the cases, the teenagers are left behind, or are not taken in any of the two populations of adults or children.

The current health leaders therefore, now have to bring to focus the needs of these particular individuals and help them in gaining necessary confidence and security to grow up into better adults. Health visitors in this regard, should also help parents of teenage children in understanding each other. These and other such policies are the requirement of the future health care, and health leaders will need to prioritize these issues to gain their lost status.

Health Visitors in Promoting Mother’s Health

Health visitors have contributed the most in the helping of new mothers and how to respond to the changes that take place after the birth of a baby. The recent reports have suggested an increase in the prevalence of postnatal depression among women. This is of significant concern, as it not only affects mothers and their future prospects, but also has effects on the development and rearing of the child. Therefore, proper identification and distinction from normal levels of anxiety felt by mothers (Hehir, 2000, np).

Now an individual health visitor is assigned to every woman who becomes pregnant and he or she takes care of the patient after delivery as well. They also allow for the provision of home delivery should the women opt to. The children are then taken care of by provision of timely immunizations. The integration via the national health system has ensured the provision of quality care to the children and helps prevent any lapses in the care (Davidson, 2003, pp 718 and 719).

It is very easy therefore, to identify what the next health leaders have to do in case of new mothers. Mothers in their initial stages may be prone to depression, anxiety and tension. The changes that they experience are seldom understood by others and many times social support is unavailable or is inaccessible. Therefore, health leaders now are working towards bringing health to mothers. This was a need that was pending for a long time, but has been recognized only fairly recently. Health leaders are now focusing on the care of the mother from pregnancy to birth and thereafter to ensure that care of children is carried out properly.

At the same time, health leaders must identify the issues that affect the mothers of today such as more work demanding schedules, juggling of children and career, neglect of self-etc. Since mothers are responsible to rising future generations, health leaders now realize the importance of providing quality health care to mothers.

Health Visitors in Promoting Elderly Health

Elderly health is another area that has benefited immensely from health visiting. Home health visiting programs have contributed greatly in reducing morbidities and mortalities and have helped improve the quality of health among the elderly. Many of the elderly populations suffer from chronic conditions such as diabetes, hypertension, heart problems and cancer (Bouman et al, 2008, np).

Most of these cases do not need any primary care or emergency hospital admission if these patients are regularly followed up and their care is provided in a timely manner. Health visitors have been particularly helpful in reducing such emergency incidences of the patients. Another pressing complication that comes in emergency is hip fractures of elderly patients. These problems have also reduced considerably due to proper care and guidance provided by the health visitors. However, it must be clarified that very frail and old patients may re quire constant medical supervision and care and not only occasional visits. Health visitors play important roles in the recognition of such patients and then make proper referrals as needed (Bouman et al, 2008, np).

Health leaders now are creating programs that provide quality and regular care to the elderly population, whether in hospice or in care centers. In both the cases, the lack of routine visit was found to be the chief complicating factor in the provision of health.

Health leaders are now working towards reducing incidences of chronic disease development in the ageing populations, as well as ensuring that patients receive their required medical care on proper time. This will help reduce hospital admissions that take place due to lack of care or vigilance, and will allow patients to spend their time in their home settings, which they prefer. With the allocation of regular health visitors, the health leaders believe they will be able to better monitor the health of such patients and provide care

Future Challenges for the Health Visitors

The future leaders of nursing must realize the next roles that they have to play in community nursing. Most of the recommendations earlier made are being carried out and there are sufficient policies made on them to make them useful and effective. However, the new areas of concern should lie in carrying out research-based work, which will show the exact effectiveness of such interventions. Since these interventions are also costly, the future researches should study the economic effects of these methods and appropriate strategies to make them cheaper yet more effective. The sociologic aspects should also be recognized and included in the various policies of health visiting (Elkan et al, 2000, np).

As stated in the workshop “let’s talk about health visiting, the many challenges of the future leaders are listed below.

• Confusion and optimism both in the profession regarding roles and potential roles that can be played
• Lack of information among customers regarding what type of service is provided by the health visitors
• Areas of mental and neurological development information and issues among the health visitors
• Trends towards universalism
• Trends towards developing better health programs for children
• Need for leaders who can direct attention towards the needs of the health visitors to the authorities
• Developing flexibility in the health visitors to up take new ideas and reforms without threatening them (Lowe, 2007, pp 13 and 14)

Health visitors are now required to display the kind of flexibility that has never been expected before. They now have to include a very good quality of health provision with their extended community roles. These roles cannot be understood unless there is the coordinated effort of the health personnel and leaders. The leaders should understand that the demands of the health visitors might be difficult to meet since they have been working on the older framework of the NHS. The lack of developments in the area has led to faults and deficiencies in the proficiency levels of these visitors.

The health leaders therefore need to include a coordination of local communities and health personnel, local government and other services in order to enhance the role of the health visitors. Understanding diversity is a very important concept in this regard, and creating health teams that are able to understand the various factors that are involved therein are essential for success (Making a Difference, 1999,pp 19). Health leaders now have to focus of creating a multidimensional team of individuals who are able to handle the new and upcoming challenges of health care and are able to provide quality health care to the community.

Since nursing leaders are suffering from lack of nurses, the current focus should be on the recruitment of new nurses, with incentives and to help them progress in health. By educating and developing various training attributes, the health visitors will have more options and flexibility in their careers and can take up more research oriented programs and tasks (Making a Difference, 1999,pp 19). Leaders need to introduce the concept of self-regulation to improve quality in health care. These and many other requirements are the need of the future health care system of the UK, and leaders can either make it or break it.

References

David Barker, 2003. The Midwife, The Coincidence and the Hypothesis. BMJ 2003; 327:1428-1430.

Maureen Beech, 2001. Implications of Integrated Nursing Teams in Primary Care. JCN Online. Web.

Kate Billingham and David Hall, 1998. Turbulent Future for School Nursing and Health Visiting. Change the Bathwater- But Hang on to the Baby. BMJ 1998; 316:406-407.

Ans Bouman, Erik van Rossum, Patricia Nelemans, Gertrudis IJM Kempen and Paul Knipschild, 2008. Effects of Intensive Home Visiting Programs for Older People with Poor Health Status: A Systematic Review. BMC Health Services Research, 8:74.

Jackie Bull, 1998. Integrated Nursing: A Review of Literature. British Journal of Community Nursing, Vol. 3, Iss. 3, pp 124-129.

Achieving Effective Practice. A Clinical Effectiveness and Research Information Pack for Nurses, Midwives and Health Visitors, nd. NHS Executive Document.

Shona Cameron and Grace Christie, 2006. Exploring Health Visitor’s Perceptions of the Public Health Nursing Role. Primary Health Care Research and Development Vol. 8, Issue 1.

Leslie Davidson, 2003. Health Systems in the United Kingdom and Their Role in Increasing Equity. Pediatrics Vol. 112, No. 3, pp 716-720.

Department of Health, 2005. CNO Bulletin, Top News. Chief Nursing Officer’s Bulletin, Issue 37.

Christopher Derrett and Lydia Burke, 2006. Editorial. The Future of Primary Care Nurses and Health Visitors. BMJ; 333:1185-1186.

Elkan R, D Kendrick, M Hewitt, JJA Robinson, K Tolley, M Blair, M Dewey, D Williams and K Brummell, 2000. The Effectiveness of Domicilliary Health Visiting: A Systematic Review of International Studies and a Selective Review of the British Literature. Health Technology Assessment; Vol. 4: No. 3.

Andrea Carlson Geilen, Eileen M McDonald, Modena E H Wilson et al, 2002. Effects of Improved Access to Safety Counseling, Products, and Home Visits on Parent’s Safety Practices. Results of a Randomized Trial. Arch Pediatr Adolesc Med. 33-40.

Brid Hehir, 2001. Is Motherhood More Depressing Than Ever? Spiked Central.

Kari J Kvaerner, Olaf G Assland, Grete S Botten, 1999. Female Medical Leadership: Cross Sectional Study. BMJ. 9; 318(7176): 91–94.

Donald W Light, 2003. Universal Health Care: Lessons from the British Experience. American Journal of Public Health, Vol. 93, No. 1, pp 25-30.

Rosalyde Lowe, 2007. Facing the Future: A Review of the Role of Health Visitors. Web.

Making a Difference, 1999. Strengthening the Nursing, Midwifery and Health Visiting Contribution to Health and Health Care.

S McCormick and J Wardrope, 2003. Article 12. Major Incidents, Leadership, and Series Summary and Review, J of Emerg Med; 20: 70-74.

Mary L O Neil, 2008. Human Resource Leadership: The Key to Improved Results in Health. Human Resources for Health, 6:10. Web.

Christine Norton and Micheal A Kamm, 2002. Specialist Nurses in Gastroenterology. J R Soc Med; 95 : 331-335.

Henry B Perry, Leslie W King Schultz, Asma S Aftab and John H Bryant, 2007. Health Equity Issues at the Local Level: Sociography, Access, and Health Outcomes in the Service Area of the Hopital Albert Schweitzer –Hasiti. D International Jourrnal for Equity in Health, 6:7. Web.

Mike Pringle, 2000. Clinical Governance in Primary Care. Participating in Clinical Governance. BMJ; 321:734-740.

Kelly Roy and Fabrice Brunet, 2005. The Role of Leadership in Overcoming Staff Turnover in Critical Care. Critical Care, 9: 422-423.

Shakespeare W. Twelfth Night II.v.158.

Richard Smith, 2003. Changing the “Leadership” of the NHS. Editor’s Choice. BMJ. Web.

Freddie Ssengooba, Syed Azizur Rehman, Charles Hongoro, Elizeus Rutemberwa, Ahmed Mustafa, Tara Kielmann and Barbara McPake, 2007. Health Sector Reforms and Human Resources for Health in Uganda and Bangladesh: Mechanisms of Effect. Human Resources for Health, 5:3. Web.

Ten Questions About Leadership, nd. Web.

Transcendent Leaders in Healthcare, nd. Web.