Health visitors are not compulsory – just like schools, nurseries and, allegedly, named persons

Note pushed through the letterbox of a parent of a four-year-old child (not of  compulsory education age) by a health visitor misrepresenting the law and exceeding his remit, while committing a heinous crime against the English language.

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“Although health visitors have no legal right of entry, they do not make a habit of pointing this out to clients”,  parents were reminded by Jean Robinson back in 2004 in an AIMS Journal article on how the service was “increasingly being dominated by surveillance, not support, with all mothers being assessed for risk of child abuse at the first meeting.”

Fast forward 13 years and the health visitor’s policing role is even more firmly entrenched as ‘early intervention’ has come to dominate the policy landscape – despite it being debunked as junk science, derived from policy-based evidence and produced to order by a bunch of vested interests.

Introduced to the UK by Tony Blair, who was obsessed with using the crystal ball of statistical probability to identify future delinquents while still in the womb, it was probably more accurately described by Tony Benn as “eugenics, the sort of thing Hitler talked about.”  

Health visitors were destined to play a leading Mystic Meg role in predicting and preventing future ‘problems’ (that may or may never arise) in families, all of which required them to hoover up sensitive personal data on all children and their parents for profiling purposes – the sort of thing that inevitably engaged Article 8 of the ECHR, but who was bothered about human rights anyway? It thus became increasingly difficult for parents to limit health visitors to offering advice on feeding and immunisations, and almost impossible to shake them off altogether.

Charlie Faulknor no doubt had very good reasons for making this freedom of information request about health visiting services in 2013 to the  Homerton University Hospital NHS Foundation Trust, and for following it up with some interesting questions about ‘fitness to parent’ forms, all of which sounded very familiar to those of us who have been chronicling similar events in Scotland.

Here are some highlights from the Trust’s initial response:

(3) How do the health visitors recruit clients into their service? i.e. how do they collect names and contact details of mothers/fathers?

• New birth notifications from Midwifery services.

• Referrals from other Trusts via child health departments, e.g. people transferring from one area to another

• Families approaching the services to request health visiting services

• Referrals from GP practices and children centres

(3a) I ask this on the presumption that many do not actively seek the health visitor, more so that the health visitor contacts the parents first. Is this the usual model of engagement?

The Healthy Child Programme and national health visiting core specification sets out the service offer for the Health Visiting Service.  At Antenatal classes parents will be informed that a health visitor will contact the family or visit between 10-14 days.  A mother who has recently given birth and visited by a midwife are also informed by the midwife to expect a health visitor to contact them. This proactive stance reduces the need for families to seek the services of the health visitor.

Aside from the presumption of expectant parents’ attendance at antenatal classes, which is by no means universal, does this even meet the legal tests for data processing without prior informed consent?

(4) Is the health visitor service optional for families and if so is this made clear (i.e. is explicit consent sought or is it implied?)?

Health visiting is a universal service that we have a duty to offer to all families with children under the age of 5 years. It is however optional for families to engage with the service. Consent to visit is sought in contact with the family as visits arranged are based on a mutual agreement with families as to where and when it will occur. Families who do not wish to engage with the service are asked to confirm this in writing if possible for clarity; but are always invited to take up our offer of a service at a later date.

Now where have we heard that one before? The craftily plotted Scottish named person scheme is also said to be a universal ‘service’ that must compulsorily be offered to all children, but those who decline it have routinely been bullied and badgered into acquiescence, sometimes with accompanying threats of referral to social work for ‘non-engagement’. Thankfully, the Supreme Court knocked that particular coercive tactic on the head in its judgment last year, but somebody should tell Grampian NHS and others who apparently have an issue with children who are ‘unseen’ by allegedly optional services.

(4a) If it is not optional, please provide the appropriate legislation which deems participation in this service compulsory

It is not compulsory – the service is offered.

And there we have it! Health visitors are not compulsory, just like nurseries and schools, but a perplexing question remains for parents in Scotland. If a health visitor is also doubling as a state guardian, how does s/he split the role when one ‘service’ is compulsory and the other is not? It all starts to get a bit complicated, probably because it is the parents’ legal responsibility to decide what is in their child’s best interests unless they consent to state interference or a court decides otherwise.

This  response to Charlie Faulkner’s follow-up request to the Homerton health trust in 2013 was also enlightening.

Do you provide access to information to other agencies or government bodies? Please specify. 

Yes, when required. Under the DPA, when required by the police or courts in pursuant to a court order or police to investigate or prevent a crime

In other words, it is in accordance with the law and compliant with the established intervention threshold.

Apart from the records filled by the health visitor (HV) from the Personal Child Health Record, are there any other forms which might be filled out by a HV? Please list the titles of each form which may be used on any visit. This request is made on the assumption that the HV may record information during or after a visit which is not part of the Personal Child Health Record, and that there is a form filled out on the initial visit which is titled something like ‘fitness to parent’. 

No forms called fitness to parent. RiO is the main documentation site and is completed in line with the questions asked on visits. The initial visit is called a newbirth visit and this is completed on RiO.  Other forms used are Health review 1 and 2, Immunisation history, bloodspot, vulnerable child, child protection.

Despite the trust’s denial of the existence of ‘fitness to parent’ forms, it all sounded remarkably familiar. Getting it right for every child forms have long been used by midwives and health visitors in Scotland to determine ‘parental capacity to provide wellbeing’ in their new add-on role as ‘named persons’ or, more accurately, ‘state guardians’.  If the Scottish government’s latest attempt to pass legislation that is actually lawful manages to clear Holyrood in the coming months  – and is not subject to a new legal challenge, which cannot be ruled out given the shambles that has been drafted –  health visitors will be acting first and foremost as state snoopers.

The Nursing and Midwifery Council (NMC) is the professional regulatory body for nurses and midwives in the UK and also applies to health visitors. Its role is “to protect patients and the public through efficient and effective regulation”.

This version of the NMC code  of conduct was referred to by the health trust in its response to Charlie Faulkner’s FOI request in 2013  and contained the following section covering confidentiality and the ‘risk of harm’ threshold for non-consensual processing of client data.

Respect people’s confidentiality

5  You must respect people’s right to confidentiality.
6  You must ensure people are informed about how and why information is shared by those who will be providing their care.
7  You must disclose information if you believe someone may be at risk of harm, in line with the law of the country in which you are practising

It even mentioned consent.

Ensure you gain consent

13  You must ensure that you gain consent before you begin any treatment or care.
14  You must respect and support people’s rights to accept or decline treatment and care.
15  You must uphold people’s rights to be fully involved in decisions about their care.

The NMC code was updated to this version in 2015, which still stresses the need to “avoid making assumptions and recognise diversity and individual choice”, as well as the need to “respect and uphold people’s human rights”. It also mentions “respect, support and document[ation of] a person’s right to accept or refuse care and treatment”.

Practitioners are expected to “balance the need to act in the best interests of people at all times with the requirement to respect a person’s right to accept or refuse treatment” and to “make sure that you get properly informed consent and document it before carrying out any action”.

On the right to privacy and confidentiality, it says “you owe a duty of confidentiality to all those who are receiving care. This includes making sure that they are informed about their care and that information about them is shared appropriately”. Clients must also be informed about “how and why information is used and shared by those providing care”, and practitioners may “share necessary information with other healthcare professionals and agencies only when the interests of patient safety and public protection override the need for confidentiality”.

So far so good, as long as it fully translates into practice on the ground, which it most certainly does not in parts of Scotland, according to parents who have reported harassment and misinformation by over-zealous health visitors. One is said to have reported a family to social work for declining a nursery place and electing to home educate their children; another “stalked” a young mum who declined her services in favour of medical professionals with specialist expertise in her children’s rare genetic condition; and another insisted that a child was illegally out of school, despite the four-year-old having not yet attained compulsory education age. Other health visitors have “peered in windows”, “tried the back door” and left notes and phone messages threatening to report families if they do not allow them entry to their homes. In one disturbing case, a first-time pregnant mother said she was placed in a state of fear and alarm by a health visitor who blocked her drive as she was trying to leave for work after being declined entry to her home. She immediately put her house on the market and left for England.

These incidents are not isolated, and if you want to share your own experience of rogue health visitors in Scotland, please get in touch or leave a comment below.

Meanwhile, here are a few extracts from a 2017 NHS Greater Glasgow and Clyde (GGC) health visitor job description

The post holder is responsible for ensuring that they and their team practice within the Legal & Ethical framework as established by Nursing & Midwifery Council (NMC) and National Legislation to ensure the patients’ interests and wellbeing are met.

Maintain accurate up-to-date clinical records and care plans in accordance with NMC standards for¨ records and record keeping, ensuring compliance with the Data Protection Act and the Freedom of Information Act.

Select and implement evidence based health visiting/public health nurse interventions to meet the individual needs of patients using national guidance and standards developed by NHS Quality Improvement Scotland, Scottish Intercollegiate Guidelines Network and Best Practice Statements.

All sounds fine until you dig into the “national guidance”, which was altered in 2013 to unlawfully embed the processing of personal data without consent on the basis of a risk to ‘wellbeing’, which is statutorily undefined and was ridiculed by Supreme Court judges in 2016 as “notably vague” and open to subjective interpretation. The correct threshold for such intervention to be lawful is ‘risk of signficant harm’ unless it is ‘necessary’ to protect vital interests, or is undertaken with consent. ‘Wellbeing’ just doesn’t cut it and will be the petard with which hapless health visitors will find themselves hoist.

Under the “most challenging parts of the job”, the NHS GGC cites the old familiar “non-compliance by clients/families with programmes of care”, even although the service is in fact optional in the absence of child protection concerns. Contrary to health visitor belief, parents are perfectly entitled to have a “different perception” without being subject to coerced compulsion or unpleasant repercussions, as the Supreme Court confirmed in paras 94-95 of its named person ruling:

…there is a risk that parents will be given the impression that they must accept advice in relation to the services offered by a named person in the exercise of the named person functions, and that their failure to cooperate would be taken as evidence of risk of harm. Care should therefore be taken to emphasise the voluntary nature of the advice,  information, support and help offered by the named person.

Respect and trust have to be earned, and judging by families’ powerful testimonies, health visitors have a very long way to go.

The new Universal Health Visiting Pathway in Scotland – Pre Birth to Pre School, which sets out “the minimum core home visiting programme to be offered to all families by Health Visitors” and consists of “11 home visits to all families – 8 within the first year of life and 3 child health reviews between 13 months and 4-5 years”, is looking less and less attractive to parents who don’t fancy having their ‘capacity to provide wellbeing’ assessed via 200+ indicators as part of a universal citizen surveillance and profiling project.

The fact that the Scottish government is so determined to impose an unwanted state guardian on to every child to ensure they follow state-dictated pathways to meet state-dictated outcomes is only going to further alienate families who value privacy as a human right. We didn’t ask for it, as is falsely claimed, and more than 36,000 of us have signed a petition rejecting the compulsory nature of the scheme, which has already been implemented unlawfully in many areas, including Fife and Highland where several vulnerable children have died.

Sadly, the propagandists in government and state-funded children’s charities, who stand to gain from contracts to ‘remediate’ families who are failing to follow their allotted pathways, have relentlessly peddled a frankly nonsensical GIRFEC cover story, which veers between being a single point of contact for parents to approach for advice (on any matter at all, apparently) and a vital child protection scheme to stop parents killing their kids. So which is it?  Child protection is, after all, deadly serious business, whereas wellbeing and happiness are merely subjectively experienced notions.

Although the SHANARRI wheel spinners have not been able to fool all of the people all of the time, they have certainly managed to fool a small army of useful idiots with some very Big Lies. Take this guy, who is apparently an expert on human rights (or maybe not) and chose to respond to this post on the NO2NP campaign’s public Facebook page:

That will be the same parents’ rights that led to the mother and her lesbian lover abusing and murdering her son or the countless other child abuse victims. The vast majority of child abuse is carried out by those that are close to the victim. Anything that reduces this appalling crime should be tried. As a parent, I would welcome a NP who identified something that as a parent, I should know but had missed because the child was reluctant to upset family dynamics by ‘outing’ an abusive family member or someone in authority close to them.

He was challenged thus:

Er no, that would be human rights as enshrined in the ECHR which only permits interference in family life when vital interests are at risk (it’s called the child protection threshold for a reason), not on the whim of some government-appointed lackey pumped up on power-over steroids who is unqualified to assess risk (of significant harm, not ‘wellbeing’). You obviously missed the documentary on the Fife child deaths where it was blindingly obvious that child protection had been sacrificed on the altar of SHANARRI by ideologues obsessed with monitoring every child’s (and parent’s) life in order to remediate them into state approved model citizens. It has been tried before, of course…. Maybe you missed 20th century history at school now that everything educational has been airbrushed out of the Curriculum for Idiocy. Presumably you also support the snoopers’ charter as “if it saves just one life” it must be worth a shot, eh? No matter that minority groups are targeted and abused as they are just collateral damage. Your reference to ‘lesbian lover’ betrays your own sad prejudices that the perpetrators’ sexuality was somehow relevant to the heinous crime in Fife. Why not read the significant case review into Liam’s death and note that the named person scheme may well have contributed to the confusion? Or even have a gander at the government minutes that confirm the named person scheme was already in place in Fife and failed, repeatedly, to detect abuse (despite countless flags being raised). I believe in saving children from abuse and murder, not placing the most vulnerable at greater risk. Others, including the Scottish goverment, clearly don’t agree that that is a legitimate aim.

As we say in Scotland, that was him telt!

Health visitors and the rest of the SHANARRI army had better start boning up on data protection and human rights laws and make sure they ‘get it right’ on each and every occasion that they decide to overrule service users’ and non-users’  wishes and choices. We’ll all be checking up on them, reporting miscreants to their professional bodies and taking the worst offenders to court. That is not a threat, but a parental pinkie promise.

[This article has been referenced in a June 2019 research report by the Scottish Home Education Forum, Home Educators’ experiences of the health visiting service in Scotland]