Journal of Public Health Medicine 22:295-301 (2000)
© 2000 Faculty of Public Health Medicine of the Royal Colleges of Physicians of the United Kingdom
Hitting the target: the equitable distribution of health visitors across caseloads
DJ Crofts0
IR Bowns1,z
TS Williams0
AS Rigby0
RP Haining2
DMB Hall0
0 Division of Child Health, Sheffield Children's Hospital, Western Bank, Sheffield S10 2TH, UK
1 School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
2 Sheffield Centre for Geographical and Spatial Analysis, Department of Geography, University of Sheffield, Winter Street, Sheffield S10 2TN, UK
z Corresponding author
E-mail: i.r.bowns@sheffield.ac.uk
Background.Health visitors in the United Kingdom work mainly with pre-school children and their mothers. Their distribution across the population is largely historical, highly variable and relates poorly to indicators of population need.
Method.A range of largely routine data sources were used to describe the nature, variation and statistical determinants of the workload of individual health visitors in Sheffield, England, in 1996-1997. Regression models were tested relating measures of need and deprivation to the total number of client contacts.
Results.Caseloads were smaller in the most deprived areas, with side variation. Most (93 per cent) contacts were with mothers and young children. Health visitors visited the clients designated as highest priority on average 4.7 times more often than routine clients. The main reasons for high priority ratings were child protection concerns, maternal mental health problems, child development and health concerns, and first-time mothers in the postnatal period. Half of all client contacts were with low-priority families for routine child health surveillance or were client initiated. Models based on the number of children under five and any one of a range of measures of social deprivation account for 57-59 per cent of variation in workload and could be used to allocate resources more equitably.
Conclusion.Although most health visitors apparently subscribe to the principle of targeting, the extent varies widely. Constraints on targeting are routine child health surveillance reviews, and client demands. More equitable allocation of health visitors and more explicit targeting policies might increase the effectiveness of the health visiting service.
Keywords: health visitor, deprivation, resource allocation, public health policy
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