Last week, the Health Visiting team at Thames View Health Centre in Barking received a delegation of Public Health nurses from Sweden. The Stockholm-based nurses were over here to learn about the experiences of health visitors in the UK and visited NELFT services in both Barking and Dagenham and Waltham Forest.

We spoke with Joy Coutts, the Operational Lead for Children’s Integrated Universal and Early Intervention Services in Barking and Dagenham, and asked for her thoughts on the visit.

How did the visit come about?

Joan Myers, NELFT’s Consultant Paediatric Nurse, is also a lecturer at London South Bank University. She was approached by the university to support Public Health nurses from Sweden and provide an opportunity for them to experience health visiting in hard to engage communities in the UK. The plan was for the nurses to visit Bristol and NELFT Waltham Forest. Unfortunately, the Bristol service was not able to facilitate, so Joan asked myself in Barking and Dagenham to accommodate. Though the two day visits were both in East London, it was thought that there were enough differences in the population to offer a contrast on how we deliver the Healthy Child Programme to different communities.

Why did they want to visit Barking & Dagenham?

The nurses asked to undertake health visiting visits across the Barking and Dagenham teams as they were aware that even geographical areas in the same borough could offer a variety of health inequalities, including poverty, housing, educational achievement - as well as specific health needs.

The Swedish nurses were able to see child health clinics, safeguarding liaison meetings, new birth visits, health reviews for 1-year and 2-year olds, as well as routine health contacts. One of the nurses attended our Child Development Centre to experience how we support children with developmental and health concerns.

Did you find similarities between the different groups' caseloads/types of issues they encounter?

In the afternoon, the nurses met the Team Leaders and myself to learn more about the Barking and Dagenham population. After a short presentation, the group then opened up to a general discussion as to how the public health role was delivered in the two countries. The Swedish system is very similar to the Healthy Child Programme we offer in UK - they don’t have ante-natal contact, but do the new births visit at 10-14 days, post-natal screening at 6-8 weeks at the baby’s health review (undertaken in clinics with paediatricians with the nurses’ support) and 1-year and 2-year health reviews. The nurses offer child health clinics, provide immunisations - but also have a paediatrician in the clinic to refer to, should there be any concerns identified with the child at the clinic contact.

Sweden has a near 20% non-Swedish born population with the highest ethnicity being Somalian. The diversity we have in Barking and Dagenham and the increase of Eastern Europeans is not seen in Sweden, which again generated conversation as to how we have to adapt our services to meet health needs in changing communities.

The biggest difference though between the two countries was that the Swedish nurses do not get involved with safeguarding or supporting the parents with their needs. The Swedish nurses could see that Health Visitors would get involved with families to really understand health issues and support. In Sweden, though there are child protection cases they are followed up by social workers and health visitors do not get involved, though they may provide health information as required. They do not have any role for intervention and would not know what the issues are when social workers were working with the families.

A topic that generated a great deal of conversation was the numbers of children accessing hospital emergency departments with ailments that could be manged in the community by either nurses or GPs. The Swedish nurses have tried to promote community services, but parents still choose the emergency rout - a very similar picture to the UK.

Will there be any future co-operation between the two groups?

The Swedish nurses have offered to reciprocate and NELFT nurses could visit them in the future, and they have already followed our Facebook and Twitter feeds. The lecturer from London South Bank University has also suggested that there may be some opportunities in the future to undertake a comparable study of outcomes comparing the delivery of the Healthy Child Programme between UK and Sweden - which could prove interesting.

The overall day went very well. The NELFT B&D HV team enjoyed having the opportunity to showcase their work. They also enjoyed discussing the role of the public health nurse in Sweden. Before the nurses came to the teams, we all thought that Sweden was a rich country, modern and clean living. To hear that there was quite a bit of poverty, similar to B&D, and that the biggest health concern is obesity in the under 5’s and school age population made us realise that there were probably more similarities than we would have expected.