There is evidence that parents want information and services around pregnancy and birth to be consistent and seamless, with different agencies and departments within health care working together, and with the family at the centre of service delivery (Public Health England (PHE) and Department of Health (DH), 2015). The 1001 Critical Days report (Leadsom et al, 2013) documented that effective, individually designed service delivery can positively affect health outcomes for women, babies and families.
Midwives and health visitors, with their expertise in child and family health, are best placed to meet the needs of families during pregnancy and the early years (DH, 2009; Bennett, 2014; Brunton et al, 2015). However, parents' experiences of service delivery in the perinatal period often describe health visiting and midwifery as separate, non-communicative services (Donetto et al, 2013). There is plenty of evidence to support collaborative working between health professionals, particularly where this will benefit the health outcomes for children and families (Gerrard et al, 2011). However, there is also evidence to demonstrate that, in practice, collaboration between midwives, health visitors and other health professionals does not always occur (Donetto et al, 2013; Calvert, 2015).
Health promotion
Every contact with women and families should influence and maximise the health and wellbeing of the family (PHE et al, 2013). Research has demonstrated that collaborative working in midwifery and health visiting is both desirable and beneficial to women, babies and families (Gerrard et al, 2011; Harris et al, 2015). From guiding vulnerable parents through pregnancy to offering support with infant feeding and promotion of public health, collaborative working may provide the best outcomes for both families and health professionals. There is a particular case for midwives and health visitors to work collaboratively when caring for families with complex needs. Women with mental health needs tend to require more support and often find a lack of collaboration between health professionals, leading to poor relationships with the family (Royal College of Midwives (RCM), 2014). When health professionals work together and involve the family, sensitive information can be easily shared among the multidisciplinary team, families are more likely to feel well supported and are protected from having to repeat their stories to multiple health professionals.
Economic benefit
There is also a financial argument to support collaborative working. The public health budget is subject to £200 million cuts as a result of government priorities to address the current economic deficit faced by the UK (Buck, 2015). Current public health evidence places an emphasis on preventive strategies to reduce health inequalities (Marmot, 2010; Munro, 2011; PHE, 2014). As midwives and health visitors have prevention of ill health and promotion of safety and wellbeing at the core of their practice (Nursing and Midwifery Council, 2015), they have a duty to intervene together at an early opportunity to implement health protection and promotion and to avoid the costly duplication of services. Health visitors are also the main health-care contact for families until children enter school (DH, 2009; 2013). This provides an opportunity to develop a relationship with the family and other health professionals, and a chance to promote public health, encouraging optimum health and wellbeing for the whole family.
Education
In the authors' experience, collaborative working between midwives and health visitors is not facilitated within the current educational curriculum. Anecdotal evidence from student experience and social media interaction suggest that collaborative working is somewhat inconsistent. Given the evidence supporting the benefits of collaborative working between the midwifery and health visiting disciplines, it seems that education is the optimum place to introduce the theoretical concept in order for it to become normative and embedded within the role of practising midwives and health visitors.
There are a number of possible reasons that joint working between midwives and health visitors is inconsistent in practice. The RCM has reported that England currently has a deficit of midwives and that 2600 more midwives are needed to support the number of births the country is experiencing (Bonar, 2015). This has a significant impact, not only for midwives working in the NHS but for women and families. Postnatal care, often dubbed the ‘Cinderella service’, is frequently subject to financial cutbacks (Bird, 2014). Overlooking the crucial period beyond birth could be putting women at risk during their most vulnerable time. Without enough midwives to offer support through this period, women and families may not be able to access the help they need to improve their health or seek advice about pregnancy and parenting. The situation for health visitors is also tenuous. The Health Visitor Implementation Plan (DH, 2011), which came to an end in 2015, was responsible for the training and recruitment of 4200 health visitors. How feasible it will be for NHS midwives and health visitors to work in partnership following this remains to be seen. Furthermore, the commissioning of health visiting services has moved from the NHS to individual local authorities, which could lead to inconsistent service provision across the UK.
‘Given the evidence supporting the benefits of collaborative working between midwifery and health visiting, it seems that education is the optimum place to introduce the theoretical concept in order for it to become normative and embedded within the role of practising midwives and health visitors’
In the higher education setting, professions that work together in the NHS are often taught separately from one another. With universities expanding rapidly, this divide is growing and health professionals no longer find themselves working as closely. It may be considered that the idea of midwifery and health visiting as two separate, unconnected services is, therefore, created before qualification. A longitudinal study by Pollard and Miers (2008) identified that when pre-registration health professionals learn together in the educational setting, students carry more positive concepts of collaborative, interprofessional relationships into practice following qualification than those who have been educated separately. Additionally, students who learn collaboratively report more confidence in their own communication and professional skills (Pollard and Miers, 2008; Ruebling et al, 2014). It is the authors' belief that higher education has a responsibility to create such opportunities for collaboration from the commencement of learning. Increased confidence, improved communication skills and knowledge of colleagues' roles can only be beneficial for students who are working to achieve optimal care for women and families.
Collaborative learning
At the University of Central Lancashire (UCLan), the School of Community Health and Midwifery has integrated collaborative working in the first year of the undergraduate midwifery programme. Collaborative working is taught during a theory block to the students, and health professionals from a variety of settings are invited to speak to the students about their role. Following this, students embark on practice placements on the postnatal ward—an area known for its multidisciplinary team working. The health visiting team was approached and asked to give a presentation on the role of the health visitor, particularly within the maternity setting. The session was a straightforward introduction to the role of the health visitor and, in return, the students were invited to talk to the health visiting lecturer about the role of the midwife, in an informal session with plenty of opportunity for discussion. The response was overwhelmingly positive. All the collaborative working theory sessions were successful; this was measured through the feedback given by the students following the presentations. The students reported that they were inspired to learn about how midwives and other health professionals could work together to provide the best care to women and families.
Conclusion
PHE and the DH (2015) have developed a document outlining the health visiting and midwifery partnership during pregnancy and the early years. It highlights the important visits and information that midwives and health visitors should offer to families throughout the antenatal and postnatal period. The document outlines the roles of the two professions separately, but recommends that midwives and health visitors build on existing collaboration to maximise their roles (PHE and DH, 2015). In education, we should be creating the platform for joint learning and working that can be built on in practice.
This year at UCLan, we will build on the multidisciplinary platform which was introduced last year, and create opportunities for students of each profession to learn together and develop an understanding of each other's roles. It is our duty in education to promote a collaborative approach to learning. By learning and working together, midwives and health visitors can offer families consistent care and advice, avoid costly and time-consuming duplication of work, develop confidence and expertise in their own skills, and better understand the skills of their colleagues.