For those of you not resident in the UK, there is a great service provided by the NHS. Health Visitors. The idea is that they provide a helping hand and in house health advice to families with young children. It kicks in straight after birth, or rather, for the first 10 days, mum and new baby is visited by a community midwife, and once all is reasonably fine, the Health Visitor takes over. Under normal circumstances, s/he will visit the new family for one month, and longer if needed. S/he is available for all questions regarding caring for a baby, but also has the task of spotting difficulties, such as postnatal depression, child protection issues, child health and safety, informing about vaccinations and how to start weaning etc. S/he is also responsible to pass on any concerns to relevant agencies, without being a social work representative.

In theory, this service is fantastic and a real example of good practice.
In practice, resources are as ever limited and even the most committed health visitor will have to prioritise. Through having become a mum and my work I've encountered situations that have left me very worried indeed.

Let's start with the personal first.
Having spoken to lots of new mums, everyone was presented with a postnatal depression questionnaire, around 6 weeks after giving birth and again later. The idea is to spot it early and refer those at risk. I never saw one. I also know that some mums who completed it honestly were considered at risk of PND, although they knew they were ok, and got referred. Yet the referral was just that, a name passed on to the GP, no follow up. In my case, I struggled at certain times, and even one month ago I wondered if I could be on the brink of PND. It would have helped to have had an outside and trained opinion. This wasn't available, and even very early on, when I had to deal with a baby who cried every waking minute of the day for weeks, and expressed my inability to cope, all the support I got was that "some babies cry" and "I'll get you on a baby massage course". Neither stopped the crying.

Yet I understand why nothing more was done. I was clearly supported by family, the house looked ok if a bit untidy, and the baby was healthy. I was not a serious case and I knew it and kept my mouth shut. Instead, I read books and forums, spoke to fellow mums and tried to get the help I needed from as many sources as possible. By now, I feel able to cope even with the worst nights and days, so no damage done.

However, there are people who are less resourceful and more vulnerable. In my work I come into contact with quite a lot of such parents. There is a single mum of three children under 5 who does not attend important doctor's appointments for a serious health issue because she does not have childcare. There is the family who live in a high rise building and have two children under 5, no access to childcare, and too scared to go out with the kids because the area is unsafe. The children are screaming their heads off for boredom in the flat. Both mums are "good" parents, but circumstances are difficult, and they have neither family nor friends who can help out and give them a break.

It should be the Health Visitors who refer such cases to Social Work and arrange for them to access respite care or even part time nursery. This doesn't happen because nursery services are overstreched and the only way to get this support is if the child is at risk and in need of immediate protection. However these cases aren't urgent, but long term, the children will suffer. They will suffer due to lack of play, because of stressed parents who can't cope, due to lack of social interaction, fresh air. Their development is likely to suffer, and they may struggle at school. Early intervention in the simple form of giving them a day at a local nursery and their parents a break could make all the difference for both children and parents. Instead, some of these families are not even visited on a regular basis, and the health visitors, knowing that resources are limited, won't refer the families. By not referring, the need is not recognised. It may be the pragmatic thing to do, but it also means that no pressure for much needed services is created, and change may never happen. And yes, the parents are clearly doing their best and the children aren't at immediate risk compared to children of substance abusers, but that doesn't mean they don't need the same support.

So here we are, trying to patch out a few things for the children and parents by piloting parental support groups with creche. Of course we work with the stretched health visiting team, they refer parents, we offer a weekly parental activity and opportunity to play for the children. We raise our concerns, and we will do some more research into the area, with appropriate recommendations to policy makers. In the meantime, we firefight a bit here and there, trying to have fun while addressing a very serious matter.