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Hello Cheryl, I am very recently out of practice (last October). I was Practice teacher and Health Visitor in a busy team. On a day with no CP conferences, CIN meeting or clinics I would typically do around 6 visits.Best wishes, Pam pam.schultz@... From: [mailto: ] On Behalf Of Cheryll Sent: 20 June 2012 09:30 Subject: Numbers of visits I wonder whether Senate members can help me? I have been asked how many visits HVs do daily these days, and the average per week. As I understand it the introduction of systems such as Rio, corporate working necessitating often long journeys from base, the scale of child protection and other factors have sometimes reduced these quite significantly. A health visitor recently told me it was often as low as 2 a day due to the amount of travel time, report writing and time spent on data entry – is this typical? Consider a day without clinics or other meetings. Clearly there will be huge variability up and down the country, but can you help me with a straw poll by telling me the rough figures where you work? Many thanks Cheryll The information contained in this email message and any attachments is confidential and is intended for the named recipient only. If you have received this message in error, please destroy it and notify the sender immediately. The unauthorised use, disclosure, copying, or alteration of this message is strictly forbidden, as is passing it to a third party without the prior permission of the sender.

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Hi there,Working from an office of 6 Hv's in a high area of need the average daily visit number varies between 4-7 not allowing for clinic days .We tend to work from 8am so report writing and records are always done the first 2 hours there are rarely Hv's in the office between 10-15.30 we have a great admin support who canvasses call into our office during the day. The only time we have less visits is when families cancel or are not in .On system one we have to clearly account for every minute of our working day , with this we need to justify any gaps or evidence unusually long periods of time spent on admin or travel.Hope this helps,Regards, Louise CremonesiniSent from my iPhoneOn 20 Jun 2012, at 09:29, Cheryll <cheryllma@...> wrote:

I wonder whether Senate members can help me? I have been asked how many visits HVs do daily these days, and the average per week. As I understand it the introduction of systems such as Rio, corporate working necessitating often long journeys from base, the scale of child protection and other factors have sometimes reduced these quite significantly. A health visitor recently told me it was often as low as 2 a day due to the amount of travel time, report writing and time spent on data entry – is this typical? Consider a day without clinics or other meetings.Clearly there will be huge variability up and down the country, but can you help me with a straw poll by telling me the rough figures where you work? Many thanksCheryll

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Hi, I am also practice teacher and carry a case load, daily visits vary new birth visits can take an hr each and then to enter in system one can take half hour, we now have to record on mum, dad and child,s record. We are now remote working which has helped but you tend to do data entry in the evening. We probably work well over 8 hrs a day. Jane Sent from my iPadOn 20 Jun 2012, at 09:46, Louise <loui_r@...> wrote:

Hi there,Working from an office of 6 Hv's in a high area of need the average daily visit number varies between 4-7 not allowing for clinic days .We tend to work from 8am so report writing and records are always done the first 2 hours there are rarely Hv's in the office between 10-15.30 we have a great admin support who canvasses call into our office during the day. The only time we have less visits is when families cancel or are not in .On system one we have to clearly account for every minute of our working day , with this we need to justify any gaps or evidence unusually long periods of time spent on admin or travel.Hope this helps,Regards, Louise CremonesiniSent from my iPhoneOn 20 Jun 2012, at 09:29, Cheryll <cheryllma@...> wrote:

I wonder whether Senate members can help me? I have been asked how many visits HVs do daily these days, and the average per week. As I understand it the introduction of systems such as Rio, corporate working necessitating often long journeys from base, the scale of child protection and other factors have sometimes reduced these quite significantly. A health visitor recently told me it was often as low as 2 a day due to the amount of travel time, report writing and time spent on data entry – is this typical? Consider a day without clinics or other meetings.Clearly there will be huge variability up and down the country, but can you help me with a straw poll by telling me the rough figures where you work? Many thanksCheryll

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Hi Cheryl,

It's not just all the extras such as computer input, staff shortages, travelling distances and CP work that has impacted on the daily HV workload - it's also the depth and required content for the visits that have changed. With reduced staffing levels, the requirements of the Healthy Child programme and the Commissioning targets to meet, the actual length of visits has changed. If you know you won't get another chance to visit that family for quite a while you have to get in as much as is feasible while you are there - so there may be fewer vists but they are possibly taking much longer. So, although it is still possible to do 6-8 visits a day the reality is that it much more likely to be anything from 2-6 depending on the focus/purpose of the visits.

From: Cheryll <cheryllma@...>" " < > Sent: Wednesday, 20 June 2012, 9:29Subject: Numbers of visits

I wonder whether Senate members can help me? I have been asked how many visits HVs do daily these days, and the average per week. As I understand it the introduction of systems such as Rio, corporate working necessitating often long journeys from base, the scale of child protection and other factors have sometimes reduced these quite significantly. A health visitor recently told me it was often as low as 2 a day due to the amount of travel time, report writing and time spent on data entry – is this typical? Consider a day without clinics or other meetings.

Clearly there will be huge variability up and down the country, but can you help me with a straw poll by telling me the rough figures where you work?

Many thanks

Cheryll

The information contained in this email message and any attachments is confidential and is intended for the named recipient only. If you have received this message in error, please destroy it and notify the sender immediately. The unauthorised use, disclosure, copying, or alteration of this message is strictly forbidden, as is passing it to a third party without the prior permission of the sender.

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Hi, Cheryll,

Whilst I was doing research with HVs in 20010/11 it was averaging about 2 or 3 more rarely 4 (urban, diverse areas, some with high deprivation levels) .

Best wishes,

Numbers of visits

I wonder whether Senate members can help me? I have been asked how many visits HVs do daily these days, and the average per week. As I understand it the introduction of systems such as Rio, corporate working necessitating often long journeys from base, the scale of child protection and other factors have sometimes reduced these quite significantly. A health visitor recently told me it was often as low as 2 a day due to the amount of travel time, report writing and time spent on data entry – is this typical? Consider a day without clinics or other meetings.

Clearly there will be huge variability up and down the country, but can you help me with a straw poll by telling me the rough figures where you work?

Many thanks

Cheryll

The information contained in this email message and any attachments is confidential and is intended for the named recipient only. If you have received this message in error, please destroy it and notify the sender immediately. The unauthorised use, disclosure, copying, or alteration of this message is strictly forbidden, as is passing it to a third party without the prior permission of the sender.

__________ Information from ESET Smart Security, version of virus signature database 7235 (20120620) __________The message was checked by ESET Smart Security.http://www.eset.com

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Clearly there is a lot of variation, thanks everybody, what are others experiences?CheryllFrom: Bidmead <christine@...>Reply- < >Date: Wed, 20 Jun 2012 17:03:49 +0100 < >Subject: Re: Numbers of visits

Hi, Cheryll, Whilst I was doing research with HVs in 20010/11 it was averaging about 2 or 3 more rarely 4 (urban, diverse areas, some with high deprivation levels) . Best wishes,

Numbers of visits

I wonder whether Senate members can help me? I have been asked how many visits HVs do daily these days, and the average per week. As I understand it the introduction of systems such as Rio, corporate working necessitating often long journeys from base, the scale of child protection and other factors have sometimes reduced these quite significantly. A health visitor recently told me it was often as low as 2 a day due to the amount of travel time, report writing and time spent on data entry ? is this typical? Consider a day without clinics or other meetings.

Clearly there will be huge variability up and down the country, but can you help me with a straw poll by telling me the rough figures where you work?

Many thanks

Cheryll

The information contained in this email message and any attachments is confidential and is intended for the named recipient only. If you have received this message in error, please destroy it and notify the sender immediately. The unauthorised use, disclosure, copying, or alteration of this message is strictly forbidden, as is passing it to a third party without the prior permission of the sender.

__________ Information from ESET Smart Security, version of virus signature database 7235 (20120620) __________The message was checked by ESET Smart Security.http://www.eset.com

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Hi Cheryl

With Rio 3 visits would be the average in my locality.

Kind regards

Dalton

Children's Service Manager

0-19 Teams

South West Locality

The Jarvis Centre

Stoughton Road

Guildford

GU1 1LS

01483 783128

07747 012053

From: [ ] On Behalf Of Pam Schultz [pam.schultz@...]

Sent: 20 June 2012 09:37

Subject: RE: Numbers of visits

Hello Cheryl, I am very recently out of practice (last October). I was Practice teacher and Health Visitor in a busy team. On a day with no CP conferences, CIN meeting or clinics I would typically

do around 6 visits.

Best wishes, Pam

pam.schultz@...

From: [mailto: ]

On Behalf Of Cheryll

Sent: 20 June 2012 09:30

Subject: Numbers of visits

I wonder whether Senate members can help me? I have been asked how many visits HVs do daily these days, and the average per week. As I understand it the introduction of systems such as Rio,

corporate working necessitating often long journeys from base, the scale of child protection and other factors have sometimes reduced these q uite significantly. A health visitor recently told me it was often as low as 2 a day due to the amount of travel time,

report writing and time spent on data entry – is this typical? Consider a day without clinics or other meetings.

Clearly there will be huge variability up and down the country, but can you help me with a straw poll by telling me the rough figures where you work?

Many thanks

Cheryll

The information contained in this email message and any attachments is confidential and is intended for the named recipient only. If you have received this message in error,

please destroy it and notify the sender immediately. The unauthorised use, disclosure, copying, or alteration of this message is strictly forbidden, as is passing it to a third party without the prior permission of the sender.

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As a student Health visitor in consolidation, I am averaging 5-7 visits a day and its manic! thats not including one or two clinics a week and a day at uni!! DawnOn 20 Jun 2012, at 22:19, Cheryll wrote:

Clearly there is a lot of variation, thanks everybody, what are others experiences?CheryllFrom: Bidmead <christine@...>Reply- < >Date: Wed, 20 Jun 2012 17:03:49 +0100 < >Subject: Re: Numbers of visits

Hi, Cheryll, Whilst I was doing research with HVs in 20010/11 it was averaging about 2 or 3 more rarely 4 (urban, diverse areas, some with high deprivation levels) . Best wishes,

Numbers of visits

I wonder whether Senate members can help me? I have been asked how many visits HVs do daily these days, and the average per week. As I understand it the introduction of systems such as Rio, corporate working necessitating often long journeys from base, the scale of child protection and other factors have sometimes reduced these quite significantly. A health visitor recently told me it was often as low as 2 a day due to the amount of travel time, report writing and time spent on data entry ? is this typical? Consider a day without clinics or other meetings.

Clearly there will be huge variability up and down the country, but can you help me with a straw poll by telling me the rough figures where you work?

Many thanks

Cheryll

The information contained in this email message and any attachments is confidential and is intended for the named recipient only. If you have received this message in error, please destroy it and notify the sender immediately. The unauthorised use, disclosure, copying, or alteration of this message is strictly forbidden, as is passing it to a third party without the prior permission of the sender. __________ Information from ESET Smart Security, version of virus signature database 7235 (20120620) __________The message was checked by ESET Smart Security.http://www.eset.com

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Hi Cheryl It really does vary as to the amount of child protection and level 2/3 that needs doing. On average I would say 4 visits. Although often it is 3. This doesn't include the amount of meetings and clinics that we have to attend. A few years ago it use to be around around 6 visits, but the type of work that we do has changed so drastically that visits now can last much longer, we also have much more admin/ computer inputting to do which seems to take up more than half my time at work. Ontop of this additional time is

now spent trying to get hold of a member of the multi disciplinary team which is so much more difficult than it use to be, especially GP's . I use to be based at a clinic opposite the linked GP surgery, however we've been moved into teams and based in a surgery which has nothing to do with my case load, with a team of health visitors. It has now become very difficult now to get hold of members of the MDT, and much time is spent on the telephone leaving messages and trying to get hold of someone. The surgery is too far away to just call in when I know the person that I need to speak to is around. So its all so very time consuming now and frustrating! From: Cheryll <cheryllma@...> Sent: Wednesday, 20 June 2012, 22:19 Subject: Re: Numbers of visits

Clearly there is a lot of variation, thanks everybody, what are others experiences?CheryllFrom: Bidmead <christine@...>Reply- < >Date: Wed, 20 Jun 2012 17:03:49 +0100 < >Subject: Re: Numbers of visits

Hi, Cheryll, Whilst I was doing research with HVs in 20010/11 it was averaging about 2 or 3 more rarely 4 (urban, diverse areas, some with high deprivation levels) . Best wishes,

Numbers of visits

I wonder whether Senate members can help me? I have been asked how many visits HVs do daily these days, and the average per week. As I understand it the introduction of systems such as Rio, corporate working necessitating often long journeys from base, the scale of child protection and other factors have sometimes reduced these quite significantly. A health visitor recently told me it was often as low as 2 a day due to the amount of travel time, report writing and time spent on data entry ? is this typical? Consider a day without clinics or other meetings.

Clearly there will be huge variability up and down the country, but can you help me with a straw poll by telling me the rough figures where you work?

Many thanks

Cheryll

The information contained in this email message and any attachments is confidential and is intended for the named recipient only. If you have received this message in error, please destroy it and notify the sender immediately. The unauthorised use, disclosure, copying, or alteration of this message is strictly forbidden, as is passing it to a third party without the prior permission of the sender.

__________ Information from ESET Smart Security, version of virus signature database 7235 (20120620) __________The message was checked by ESET Smart Security.http://www.eset.com/

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Hi There,I think whether it be System One or Rio, the longer you use them the quicker you become , if configured appropriately System One can help reduce time spent on admin tasks an example is the electronic births record.I have used System One in two areas and currently in Cambridgeshire we can do all sorts of fancy stuff , templates for safeguarding can save time, there is also the possibility of cut and paste if using multiple records which tends to be the case. We also have an excellent System One lead who also happens to be a HV, she has been instrumental at making it work more efficiently for us. Now that GP's are coming onto System too the communication between GP's and ourselves is also improving , similar to Emis we can send

them instant messages , we can also access their consultations and they ours instantly. I believe admin support is key in ensuring HV's spend their time doing what we should be doing. Until last year like many HV's we all did our own letters/all admin/booking interpreters/filing. Now all of this is tasked to admin support via System One, letter templates are then amended and sent out and the appointment is put onto the System One ledger by admin.It's simple economics , we are very expensive administrators Kind Regards,Louise From: SARAH HUGHES <sarahforsyth7ry@...> " " < > Sent: Thursday, 21 June 2012, 12:44 Subject: Re: Numbers of visits

Hi Cheryl It really does vary as to the amount of child protection and level 2/3 that needs doing. On average I would say 4 visits. Although often it is 3. This doesn't include the amount of meetings and clinics that we have to attend. A few years ago it use to be around around 6 visits, but the type of work that we do has changed so drastically that visits now can last much longer, we also have much more admin/ computer inputting to do which seems to take up more than half my time at work.

Ontop of this additional time is

now spent trying to get hold of a member of the multi disciplinary team which is so much more difficult than it use to be, especially GP's . I use to be based at a clinic opposite the linked GP surgery, however we've been moved into teams and based in a surgery which has nothing to do with my case load, with a team of health visitors. It has now become very difficult now to get hold of members of the MDT, and much time is spent on the telephone leaving messages and trying to get hold of someone. The surgery is too far away to just call in when I know the person that I need to speak to is around. So its all so very time consuming now and

frustrating! From: Cheryll <cheryllma@...> Sent: Wednesday, 20 June 2012, 22:19 Subject: Re: Numbers of visits

Clearly there is a lot of variation, thanks everybody, what are others experiences?CheryllFrom: Bidmead <christine@...>Reply- < >Date: Wed, 20 Jun 2012 17:03:49 +0100 < >Subject: Re: Numbers of visits

Hi, Cheryll, Whilst I was doing research with HVs in 20010/11 it was averaging about 2 or 3 more rarely 4 (urban, diverse areas, some with high deprivation levels) . Best wishes,

Numbers of visits

I wonder whether Senate members can help me? I have been asked how many visits HVs do daily these days, and the average per week. As I understand it the introduction of systems such as Rio, corporate working necessitating often long journeys from base, the scale of child protection and other factors have sometimes reduced these quite significantly. A health visitor recently told me it was often as low as 2 a day due to the amount of travel time, report writing and time spent on data entry ? is this typical? Consider a day without clinics or other meetings.

Clearly there will be huge variability up and down the country, but can you help me with a straw poll by telling me the rough figures where you work?

Many thanks

Cheryll

The information contained in this email message and any attachments is confidential and is intended for the named recipient only. If you have received this message in error, please destroy it and notify the sender immediately. The unauthorised use, disclosure, copying, or alteration of this message is strictly forbidden, as is passing it to a third party without the prior permission of the sender.

__________ Information from ESET Smart Security, version of virus signature database 7235 (20120620) __________The message was checked by ESET Smart Security.http://www.eset.com/

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Hi Lou Thanks for your comments. System one has only just been rolled out in our area, so it is taking everyone a long time to work out their way around it . After your comments I now live in hope that actually time will be reduced once we learn this new system! From: Lou <loui_r@...> " " < > Sent: Thursday, 21 June 2012, 15:13 Subject: Re: Numbers of visits

Hi There,I think whether it be System One or Rio, the longer you use them the quicker you become , if configured appropriately System One can help reduce time spent on admin tasks an example is the electronic births record.I have used System One in two areas and currently in Cambridgeshire we can do all sorts of fancy stuff , templates for safeguarding can save time, there is also the possibility of cut and paste if using multiple records which tends to be the case. We also have an excellent System One lead who also happens to be a HV, she has been instrumental at making it work more efficiently for us. Now that GP's are coming onto System too the communication between GP's and ourselves is also improving , similar

to Emis we can send

them instant messages , we can also access their consultations and they ours instantly. I believe admin support is key in ensuring HV's spend their time doing what we should be doing. Until last year like many HV's we all did our own letters/all admin/booking interpreters/filing. Now all of this is tasked to admin support via System One, letter templates are then amended and sent out and the appointment is put onto the System One ledger by admin.It's simple economics , we are very expensive administrators Kind Regards,Louise From: SARAH HUGHES <sarahforsyth7ry@...> " " < > Sent: Thursday, 21 June 2012, 12:44 Subject: Re: Numbers of visits

Hi Cheryl It really does vary as to the amount of child protection and level 2/3 that needs doing. On average I would say 4 visits. Although often it is 3. This doesn't include the amount of meetings and clinics that we have to attend. A few years ago it use to be around around 6 visits, but the type of work that we do has changed so drastically that visits now can last much longer, we also have much more admin/ computer inputting to do which seems to take up more than half my time at work.

Ontop of this additional time is

now spent trying to get hold of a member of the multi disciplinary team which is so much more difficult than it use to be, especially GP's . I use to be based at a clinic opposite the linked GP surgery, however we've been moved into teams and based in a surgery which has nothing to do with my case load, with a team of health visitors. It has now become very difficult now to get hold of members of the MDT, and much time is spent on the telephone leaving messages and trying to get hold of someone. The surgery is too far away to just call in when I know the person that I need to speak to is around. So its all so very time consuming now and

frustrating! From: Cheryll <cheryllma@...> Sent: Wednesday, 20 June 2012, 22:19 Subject: Re: Numbers of visits

Clearly there is a lot of variation, thanks everybody, what are others experiences?CheryllFrom: Bidmead <christine@...>Reply- < >Date: Wed, 20 Jun 2012 17:03:49 +0100 < >Subject: Re: Numbers of visits

Hi, Cheryll, Whilst I was doing research with HVs in 20010/11 it was averaging about 2 or 3 more rarely 4 (urban, diverse areas, some with high deprivation levels) . Best wishes,

Numbers of visits

I wonder whether Senate members can help me? I have been asked how many visits HVs do daily these days, and the average per week. As I understand it the introduction of systems such as Rio, corporate working necessitating often long journeys from base, the scale of child protection and other factors have sometimes reduced these quite significantly. A health visitor recently told me it was often as low as 2 a day due to the amount of travel time, report writing and time spent on data entry ? is this typical? Consider a day without clinics or other meetings.

Clearly there will be huge variability up and down the country, but can you help me with a straw poll by telling me the rough figures where you work?

Many thanks

Cheryll

The information contained in this email message and any attachments is confidential and is intended for the named recipient only. If you have received this message in error, please destroy it and notify the sender immediately. The unauthorised use, disclosure, copying, or alteration of this message is strictly forbidden, as is passing it to a third party without the prior permission of the sender.

__________ Information from ESET Smart Security, version of virus signature database 7235 (20120620) __________The message was checked by ESET Smart Security.http://www.eset.com/

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Hi ,Indeed ,stay optimistic we have had it for two years for the first 6-9 months we were down to only 2 visits a day sanctioned by management because everything took so long to input. We are now paperless and I couldn't work without it ! You really do need a champion with a HV background deciding which templates to adopt.Regards,Louise From: SARAH HUGHES <sarahforsyth7ry@...> " " < > Sent: Thursday, 21 June 2012, 15:40 Subject: Re: Numbers of visits

Hi Lou Thanks for your comments. System one has only just been rolled out in our area, so it is taking everyone a long time to work out their way around it . After your comments I now live in hope that actually time will be reduced once we learn this new system! From: Lou <loui_r@...>

" " < > Sent: Thursday, 21 June 2012, 15:13 Subject: Re: Numbers of visits

Hi There,I think whether it be System One or Rio, the longer you use them the quicker you become , if configured appropriately System One can help reduce time spent on admin tasks an example is the electronic births record.I have used System One in two areas and currently in Cambridgeshire we can do all sorts of fancy stuff , templates for safeguarding can save time, there is also the possibility of cut and paste if using multiple records which tends to be the case. We also have an excellent System One lead who also happens to be a HV, she has been instrumental at making it work more efficiently for us. Now that GP's are coming onto System too the communication between GP's and ourselves is also improving ,

similar

to Emis we can send

them instant messages , we can also access their consultations and they ours instantly. I believe admin support is key in ensuring HV's spend their time doing what we should be doing. Until last year like many HV's we all did our own letters/all admin/booking interpreters/filing. Now all of this is tasked to admin support via System One, letter templates are then amended and sent out and the appointment is put onto the System One ledger by admin.It's simple economics , we are very expensive administrators Kind Regards,Louise From: SARAH HUGHES <sarahforsyth7ry@...> " " < > Sent: Thursday, 21 June 2012, 12:44 Subject: Re: Numbers of visits

Hi Cheryl It really does vary as to the amount of child protection and level 2/3 that needs doing. On average I would say 4 visits. Although often it is 3. This doesn't include the amount of meetings and clinics that we have to attend. A few years ago it use to be around around 6 visits, but the type of work that we do has changed so drastically that visits now can last much longer, we also have much more admin/ computer inputting to do which seems to take up more than half my time at work.

Ontop of this additional time is

now spent trying to get hold of a member of the multi disciplinary team which is so much more difficult than it use to be, especially GP's . I use to be based at a clinic opposite the linked GP surgery, however we've been moved into teams and based in a surgery which has nothing to do with my case load, with a team of health visitors. It has now become very difficult now to get hold of members of the MDT, and much time is spent on the telephone leaving messages and trying to get hold of someone. The surgery is too far away to just call in when I know the person that I need to speak to is around. So its all so very time consuming now and

frustrating! From: Cheryll <cheryllma@...> Sent: Wednesday, 20 June 2012, 22:19 Subject: Re: Numbers of visits

Clearly there is a lot of variation, thanks everybody, what are others experiences?CheryllFrom: Bidmead <christine@...>Reply- < >Date: Wed, 20 Jun 2012 17:03:49 +0100 < >Subject: Re: Numbers of visits

Hi, Cheryll, Whilst I was doing research with HVs in 20010/11 it was averaging about 2 or 3 more rarely 4 (urban, diverse areas, some with high deprivation levels) . Best wishes,

Numbers of visits

I wonder whether Senate members can help me? I have been asked how many visits HVs do daily these days, and the average per week. As I understand it the introduction of systems such as Rio, corporate working necessitating often long journeys from base, the scale of child protection and other factors have sometimes reduced these quite significantly. A health visitor recently told me it was often as low as 2 a day due to the amount of travel time, report writing and time spent on data entry ? is this typical? Consider a day without clinics or other meetings.

Clearly there will be huge variability up and down the country, but can you help me with a straw poll by telling me the rough figures where you work?

Many thanks

Cheryll

The information contained in this email message and any attachments is confidential and is intended for the named recipient only. If you have received this message in error, please destroy it and notify the sender immediately. The unauthorised use, disclosure, copying, or alteration of this message is strictly forbidden, as is passing it to a third party without the prior permission of the sender.

__________ Information from ESET Smart Security, version of virus signature database 7235 (20120620) __________The message was checked by ESET Smart Security.http://www.eset.com/

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Hi ,Indeed ,stay optimistic we have had it for two years for the first 6-9 months we were down to only 2 visits a day sanctioned by management because everything took so long to input. We are now paperless and I couldn't work without it ! You really do need a champion with a HV background deciding which templates to adopt.Regards,Louise From: SARAH HUGHES <sarahforsyth7ry@...> " " < > Sent: Thursday, 21 June 2012, 15:40 Subject: Re: Numbers of visits

Hi Lou Thanks for your comments. System one has only just been rolled out in our area, so it is taking everyone a long time to work out their way around it . After your comments I now live in hope that actually time will be reduced once we learn this new system! From: Lou <loui_r@...>

" " < > Sent: Thursday, 21 June 2012, 15:13 Subject: Re: Numbers of visits

Hi There,I think whether it be System One or Rio, the longer you use them the quicker you become , if configured appropriately System One can help reduce time spent on admin tasks an example is the electronic births record.I have used System One in two areas and currently in Cambridgeshire we can do all sorts of fancy stuff , templates for safeguarding can save time, there is also the possibility of cut and paste if using multiple records which tends to be the case. We also have an excellent System One lead who also happens to be a HV, she has been instrumental at making it work more efficiently for us. Now that GP's are coming onto System too the communication between GP's and ourselves is also improving ,

similar

to Emis we can send

them instant messages , we can also access their consultations and they ours instantly. I believe admin support is key in ensuring HV's spend their time doing what we should be doing. Until last year like many HV's we all did our own letters/all admin/booking interpreters/filing. Now all of this is tasked to admin support via System One, letter templates are then amended and sent out and the appointment is put onto the System One ledger by admin.It's simple economics , we are very expensive administrators Kind Regards,Louise From: SARAH HUGHES <sarahforsyth7ry@...> " " < > Sent: Thursday, 21 June 2012, 12:44 Subject: Re: Numbers of visits

Hi Cheryl It really does vary as to the amount of child protection and level 2/3 that needs doing. On average I would say 4 visits. Although often it is 3. This doesn't include the amount of meetings and clinics that we have to attend. A few years ago it use to be around around 6 visits, but the type of work that we do has changed so drastically that visits now can last much longer, we also have much more admin/ computer inputting to do which seems to take up more than half my time at work.

Ontop of this additional time is

now spent trying to get hold of a member of the multi disciplinary team which is so much more difficult than it use to be, especially GP's . I use to be based at a clinic opposite the linked GP surgery, however we've been moved into teams and based in a surgery which has nothing to do with my case load, with a team of health visitors. It has now become very difficult now to get hold of members of the MDT, and much time is spent on the telephone leaving messages and trying to get hold of someone. The surgery is too far away to just call in when I know the person that I need to speak to is around. So its all so very time consuming now and

frustrating! From: Cheryll <cheryllma@...> Sent: Wednesday, 20 June 2012, 22:19 Subject: Re: Numbers of visits

Clearly there is a lot of variation, thanks everybody, what are others experiences?CheryllFrom: Bidmead <christine@...>Reply- < >Date: Wed, 20 Jun 2012 17:03:49 +0100 < >Subject: Re: Numbers of visits

Hi, Cheryll, Whilst I was doing research with HVs in 20010/11 it was averaging about 2 or 3 more rarely 4 (urban, diverse areas, some with high deprivation levels) . Best wishes,

Numbers of visits

I wonder whether Senate members can help me? I have been asked how many visits HVs do daily these days, and the average per week. As I understand it the introduction of systems such as Rio, corporate working necessitating often long journeys from base, the scale of child protection and other factors have sometimes reduced these quite significantly. A health visitor recently told me it was often as low as 2 a day due to the amount of travel time, report writing and time spent on data entry ? is this typical? Consider a day without clinics or other meetings.

Clearly there will be huge variability up and down the country, but can you help me with a straw poll by telling me the rough figures where you work?

Many thanks

Cheryll

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Hi Senate MembersI have been following the conversations but think the focus should be on how much time is actually spent with the client. I could complete 2 visits and spend 4 - 5 hours of my day with clients especially if they are in crisis and need interventions from other services. I work in a very deprived area in East London. Sometimes I go to a client to follow up a Police Merlin report. Often this is the first contact the family has with the HV service as we serve a very mobile population. The client discloses severe domestic abuse because they are scared to report it to the Police and you have to start making referrals from the client's home. On other days I complete more visits, up to 5 but spend less time with clients as I spend more time travelling and record keeping.It's important to measure what we do and what difference we make. But I don't feel the number of visits we undertake is an accurate measure of what we do. I feel that the time spent with the client intervening early or managing a crisis to prevent it from escalating is more important.Where I work we use EMIS web to record activity - the actual time spent with/on the client - face to face time, telephone contacts, liaison, data entry, etc. We also record outcomes - what difference we actually make. I'm concerned that counting the number of visits we do does not really demonstrate the value of the great work we do with our clients. And doing more visits does not necessarily mean that we make a difference to more people.RegardsRuth Oshikanlu Sent from my iPhoneOn 20 Jun 2012, at 09:29, Cheryll <cheryllma@...> wrote:

I wonder whether Senate members can help me? I have been asked how many visits HVs do daily these days, and the average per week. As I understand it the introduction of systems such as Rio, corporate working necessitating often long journeys from base, the scale of child protection and other factors have sometimes reduced these quite significantly. A health visitor recently told me it was often as low as 2 a day due to the amount of travel time, report writing and time spent on data entry – is this typical? Consider a day without clinics or other meetings.Clearly there will be huge variability up and down the country, but can you help me with a straw poll by telling me the rough figures where you work? Many thanksCheryll The information contained in this email message and any attachments is

confidential and is intended for the named recipient only. If you have received

this message in error, please destroy it and notify the sender immediately. The

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I agree with Ruth.  Mine was one of the first responses to this discussion and I’d said round about 6 on a more “routine†day, as a ball-park number.  However, that gave no explanation or background.  Mostly that was in a 9 hour day (I worked a long day), and would vary very much.  As others have said, with a family in crisis the numbers would fall.  Indeed when visiting some families with complex health need, and or safeguarding concerns I have frequently had to cancel and re-schedule further visits for that morning or afternoon Before the “Call To Action†a health visiting audit was done in our area to look in depth at the work HV’s were undertaking, and perhaps as expected it showed a huge variation in number of visits, travel time, safeguarding work, etc etc.  This reflected the geography of the area, as well as level of need as the area is rural, but with two or three very urbanised areas with pockets of deprivation. Others have said about the time taken to enter on system one, as well as written recording/documenting.  I think my experience reflects much of what has been said, so 1-2 hours per day if all is recorded the same day, which was not always possible. I feel  Ruth’s comment on capturing the value of time spent with clients families, and the difference we make is really important, and I feel sadly lacking with the technology in place locally.  An awful lot of input is very much around health-care data collection, and very medicalised in tone, which is unsurprising as it was designed with medics and acute care in mind. A very interesting & important discussion…….Pam   From: [mailto: ] On Behalf Of Ruth OshikanluSent: 28 June 2012 02:37 Subject: Re: Numbers of visits Hi Senate Members I have been following the conversations but think the focus should be on how much time is actually spent with the client. I could complete 2 visits and spend 4 - 5 hours of my day with clients especially if they are in crisis and need interventions from other services. I work in a very deprived area in East London. Sometimes I go to a client to follow up a Police Merlin report. Often this is the first contact the family has with the HV service as we serve a very mobile population. The client discloses severe domestic abuse because they are scared to report it to the Police and you have to start making referrals from the client's home. On other days I complete more visits, up to 5 but spend less time with clients as I spend more time travelling and record keeping. It's important to measure what we do and what difference we make. But I don't feel the number of visits we undertake is an accurate measure of what we do. I feel that the time spent with the client intervening early or managing a crisis to prevent it from escalating is more important. Where I work we use EMIS web to record activity - the actual time spent with/on the client - face to face time, telephone contacts, liaison, data entry, etc. We also record outcomes - what difference we actually make. I'm concerned that counting the number of visits we do does not really demonstrate the value of the great work we do with our clients. And doing more visits does not necessarily mean that we make a difference to more people. Regards Ruth Oshikanlu Sent from my iPhoneOn 20 Jun 2012, at 09:29, Cheryll <cheryllma@...> wrote: I wonder whether Senate members can help me? I have been asked how many visits HVs do daily these days, and the average per week. As I understand it the introduction of systems such as Rio, corporate working necessitating often long journeys from base, the scale of child protection and other factors have sometimes reduced these quite significantly. A health visitor recently told me it was often as low as 2 a day due to the amount of travel time, report writing and time spent on data entry – is this typical? Consider a day without clinics or other meetings. Clearly there will be huge variability up and down the country, but can you help me with a straw poll by telling me the rough figures where you work? Many thanks Cheryll The information contained in this email message and any attachments is confidential and is intended for the named recipient only. If you have received this message in error, please destroy it and notify the sender immediately. The unauthorised use, disclosure, copying, or alteration of this message is strictly forbidden, as is passing it to a third party without the prior permission of the sender. =

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Thank you both very much, what you highlight it the complexity of this area which was why we didn't put out ideal client:HV ratios when I worked for CPHVA. Ultimately we did as the caseload sizes had become so alarming and Cowley had published some research to back our position.In a sense there are two big concerns, one that health visitors can 'see the job through' and sort out all that needs sorting with the family, not just do a superficial job and have to go back and back whilst the situation for the child may be deteriorating. However the second is about getting the support systems right, something that we have never achieved in my career. Are there Senate members who feel that the support around them, particularly data collection, facilitates and improves their practice? It would be good if you would share the success factors. I know someone did earlier in the discussion.Kind regardsCheryll The information contained in this email message and any attachments is

confidential and is intended for the named recipient only. If you have received

this message in error, please destroy it and notify the sender immediately. The

unauthorised use, disclosure, copying, or alteration of this message is

strictly forbidden, as is passing it to a third party without the prior

permission of the sender. From: Pam Schultz <pam.schultz@...>Reply- < >Date: Thu, 28 Jun 2012 04:58:25 +0100 < >Subject: RE: Numbers of visits

I agree with Ruth. Mine was one of the first responses to this discussion and I’d said round about 6 on a more “routine” day, as a ball-park number. However, that gave no explanation or background. Mostly that was in a 9 hour day (I worked a long day), and would vary very much. As others have said, with a family in crisis the numbers would fall. Indeed when visiting some families with complex health need, and or safeguarding concerns I have frequently had to cancel and re-schedule further visits for that morning or afternoon Before the “Call To Action” a health visiting audit was done in our area to look in depth at the work HV’s were undertaking, and perhaps as expected it showed a huge variation in number of visits, travel time, safeguarding work, etc etc. This reflected the geography of the area, as well as level of need as the area is rural, but with two or three very urbanised areas with pockets of deprivation. Others have said about the time taken to enter on system one, as well as written recording/documenting. I think my experience reflects much of what has been said, so 1-2 hours per day if all is recorded the same day, which was not always possible. I feel Ruth’s comment on capturing the value of time spent with clients families, and the difference we make is really important, and I feel sadly lacking with the technology in place locally. An awful lot of input is very much around health-care data collection, and very medicalised in tone, which is unsurprising as it was designed with medics and acute care in mind. A very interesting & important discussion…….Pam From: [mailto: ] On Behalf Of Ruth OshikanluSent: 28 June 2012 02:37 Subject: Re: Numbers of visits Hi Senate Members I have been following the conversations but think the focus should be on how much time is actually spent with the client. I could complete 2 visits and spend 4 - 5 hours of my day with clients especially if they are in crisis and need interventions from other services. I work in a very deprived area in East London. Sometimes I go to a client to follow up a Police Merlin report. Often this is the first contact the family has with the HV service as we serve a very mobile population. The client discloses severe domestic abuse because they are scared to report it to the Police and you have to start making referrals from the client's home. On other days I complete more visits, up to 5 but spend less time with clients as I spend more time travelling and record keeping. It's important to measure what we do and what difference we make. But I don't feel the number of visits we undertake is an accurate measure of what we do. I feel that the time spent with the client intervening early or managing a crisis to prevent it from escalating is more important. Where I work we use EMIS web to record activity - the actual time spent with/on the client - face to face time, telephone contacts, liaison, data entry, etc. We also record outcomes - what difference we actually make. I'm concerned that counting the number of visits we do does not really demonstrate the value of the great work we do with our clients. And doing more visits does not necessarily mean that we make a difference to more people. Regards Ruth Oshikanlu Sent from my iPhoneOn 20 Jun 2012, at 09:29, Cheryll <cheryllma@...> wrote: I wonder whether Senate members can help me? I have been asked how many visits HVs do daily these days, and the average per week. As I understand it the introduction of systems such as Rio, corporate working necessitating often long journeys from base, the scale of child protection and other factors have sometimes reduced these quite significantly. A health visitor recently told me it was often as low as 2 a day due to the amount of travel time, report writing and time spent on data entry – is this typical? Consider a day without clinics or other meetings. Clearly there will be huge variability up and down the country, but can you help me with a straw poll by telling me the rough figures where you work? Many thanks Cheryll The information contained in this email message and any attachments is confidential and is intended for the named recipient only. If you have received this message in error, please destroy it and notify the sender immediately. The unauthorised use, disclosure, copying, or alteration of this message is strictly forbidden, as is passing it to a third party without the prior permission of the sender. =

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Cheryll, in the long run the Cabinet think the Public Sector Network will enable

better information sharing between agencies across the Community...

I doubt that this would help much with the 'universal' problems in families like

poor housing or debt, but it might help with the small number of 'Troubled

Families' where information about a father in prison or previous infant deaths

could help with organising a Team Around The Baby.

In the next year or so, as the Health & Social Care Act spreads its chaotic way

around primary care and local authorities, it is vital that health visitors take

a lead in shaping the new-look Annual Public Health Reports as they evolve for

HWBs: in the twilight of the Health Authorities 10 years ago, this input made a

big 'local' difference (Van Der Puije H, Blackburn R, E, Crosby J,

Doyle G, B, Hart A, Scammel C, Caan W. Raising health visitors’

profile. Community Practitioner 2001; 74: 163).

Interesting times..... off later to the Guardian for their 'dialogue' about the

future of public health. As the workforce shrinks in public health medicine,

health promotion, medical statistics & epidemiology/informatics and the

'regenerated' health visiting workforce grows, the balance of influence (= Soft

Power) should shift towards HVs. Is there a strategy for this, or will the

Government's divide-and-conquer approach (otherwise known as Localism and

Choice) prevent any new influence for Health?

Woody.

________________________________________

From: [ ] On Behalf Of

Cheryll [cheryllma@...]

Sent: 28 June 2012 08:48

Subject: {Disarmed} Re: Numbers of visits

Thank you both very much, what you highlight it the complexity of this area

which was why we didn't put out ideal client:HV ratios when I worked for CPHVA.

Ultimately we did as the caseload sizes had become so alarming and Cowley

had published some research to back our position.

In a sense there are two big concerns, one that health visitors can 'see the job

through' and sort out all that needs sorting with the family, not just do a

superficial job and have to go back and back whilst the situation for the child

may be deteriorating. However the second is about getting the support systems

right, something that we have never achieved in my career.

Are there Senate members who feel that the support around them, particularly

data collection, facilitates and improves their practice? It would be good if

you would share the success factors. I know someone did earlier in the

discussion.

Kind regards

Cheryll

The information contained in this email message and any attachments is

confidential and is intended for the named recipient only. If you have received

this message in error, please destroy it and notify the sender immediately. The

unauthorised use, disclosure, copying, or alteration of this message is strictly

forbidden, as is passing it to a third party without the prior permission of the

sender.

From: Pam Schultz

<pam.schultz@...<mailto:pam.schultz@...>>

Reply-< <mailto: >>

Date: Thu, 28 Jun 2012 04:58:25 +0100

< <mailto: >>

Subject: RE: Numbers of visits

I agree with Ruth. Mine was one of the first responses to this discussion and

I’d said round about 6 on a more “routine” day, as a ball-park number. However,

that gave no explanation or background.

Mostly that was in a 9 hour day (I worked a long day), and would vary very much.

As others have said, with a family in crisis the numbers would fall. Indeed

when visiting some families with complex health need, and or safeguarding

concerns I have frequently had to cancel and re-schedule further visits for that

morning or afternoon

Before the “Call To Action” a health visiting audit was done in our area to look

in depth at the work HV’s were undertaking, and perhaps as expected it showed a

huge variation in number of visits, travel time, safeguarding work, etc etc.

This reflected the geography of the area, as well as level of need as the area

is rural, but with two or three very urbanised areas with pockets of

deprivation.

Others have said about the time taken to enter on system one, as well as written

recording/documenting. I think my experience reflects much of what has been

said, so 1-2 hours per day if all is recorded the same day, which was not always

possible.

I feel Ruth’s comment on capturing the value of time spent with clients

families, and the difference we make is really important, and I feel sadly

lacking with the technology in place locally. An awful lot of input is very

much around health-care data collection, and very medicalised in tone, which is

unsurprising as it was designed with medics and acute care in mind.

A very interesting & important discussion…….

Pam

From: <mailto: >

[mailto: ] On Behalf Of Ruth Oshikanlu

Sent: 28 June 2012 02:37

<mailto: >

Subject: Re: Numbers of visits

Hi Senate Members

I have been following the conversations but think the focus should be on how

much time is actually spent with the client. I could complete 2 visits and spend

4 - 5 hours of my day wit h clients especially if they are in crisis and need

interventions fro m other services. I work in a very deprived area in East

London. Sometimes I go to a client to follow up a Police Merlin report. Often

this is the first contact the family has with the HV service as we serve a very

mobile population. The client discloses severe domestic abuse because they are

scared to report it to the Police and you have to start making referrals from

the client's home. On other days I complete more visits, up to 5 but spend less

time with clients as I spend more time travelling and record keeping.

It's important to measure what we do and what difference we make. But I don't

feel the number of visits we undertake is an accurate measure of what we do. I

feel that the time spent with the client intervening early or managing a crisis

to prevent it from escalating is more important.

Where I work we use EMIS web to record activity - the actual time spent with/on

the client - face to face time, telephone contacts, liaison, data entry, etc. We

also record outcomes - what difference we actually make. I'm concerned that

counting the number of visits we do does not really demonstrate the value of the

great work we do with our clients. And doing more visits does not necessarily

mean that we make a difference to more people.

Regards

Ruth Oshikanlu

Sent from my iPhone

On 20 Jun 2012, at 09:29, Cheryll

<cheryllma@...<mailto:cheryllma@...>> wrote:

I wo nder whether Senate members can help me? I have been asked how many visits

HVs do daily these days, and the average per week. As I understand it the

introduction of systems such as Rio, corporate working necessitating often long

journeys from base, the scale of child protection and other factors have

sometimes reduced these quite significantly. A health visitor recently told me

it was often as low as 2 a day due to the amount of travel time, report writing

and time spent on data entry – is this typical? Consider a day without clinics

or other meetings.

Clearly there will be huge variability up and down the country, but can you help

me with a straw poll by telling me the rough figures where you work?

Many thanks

Cheryll

The information contained in this email message and any attachments is

confidential and is intended for the named recipient only. If you have received

this message in error, please destroy it and notify the sender immediately. The

unauthorised use, disclosure, copying, or alteration of this message is strictly

forbidden, as is passing it to a third party without the prior permission of the

sender.

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However I think there is a real issue in only counting face to face work. That is what companies like kpmg do! If you do that it looks like you only spend half your time with clients then commissioners say they can cut services by half. And even though they cannot cut health visiting at the moment they will cut skill mix and all your support services.There needs to be an evaluation of face to face work, advocacy, population level work, partnership work and amount of time spent on the bureaucracy that underpins safeguarding as well as broader work around influencing policy. It may be helpful to evaluate health visiting against the four principles and a call to action?LizSent using BlackBerry® from OrangeFrom: Ruth Oshikanlu <rutholut@...>Sender: Date: Thu, 28 Jun 2012 02:37:14 +0100 < >Reply Subject: Re: Numbers of visits Hi Senate MembersI have been following the conversations but think the focus should be on how much time is actually spent with the client. I could complete 2 visits and spend 4 - 5 hours of my day with clients especially if they are in crisis and need interventions from other services. I work in a very deprived area in East London. Sometimes I go to a client to follow up a Police Merlin report. Often this is the first contact the family has with the HV service as we serve a very mobile population. The client discloses severe domestic abuse because they are scared to report it to the Police and you have to start making referrals from the client's home. On other days I complete more visits, up to 5 but spend less time with clients as I spend more time travelling and record keeping.It's important to measure what we do and what difference we make. But I don't feel the number of visits we undertake is an accurate measure of what we do. I feel that the time spent with the client intervening early or managing a crisis to prevent it from escalating is more important.Where I work we use EMIS web to record activity - the actual time spent with/on the client - face to face time, telephone contacts, liaison, data entry, etc. We also record outcomes - what difference we actually make. I'm concerned that counting the number of visits we do does not really demonstrate the value of the great work we do with our clients. And doing more visits does not necessarily mean that we make a difference to more people.RegardsRuth Oshikanlu Sent from my iPhoneOn 20 Jun 2012, at 09:29, Cheryll <cheryllma@...> wrote: I wonder whether Senate members can help me? I have been asked how many visits HVs do daily these days, and the average per week. As I understand it the introduction of systems such as Rio, corporate working necessitating often long journeys from base, the scale of child protection and other factors have sometimes reduced these quite significantly. A health visitor recently told me it was often as low as 2 a day due to the amount of travel time, report writing and time spent on data entry – is this typical? Consider a day without clinics or other meetings.Clearly there will be huge variability up and down the country, but can you help me with a straw poll by telling me the rough figures where you work? Many thanksCheryll The information contained in this email message and any attachments isconfidential and is intended for the named recipient only. If you have receivedthis message in error, please destroy it and notify the sender immediately. Theunauthorised use, disclosure, copying, or alteration of this message isstrictly forbidden, as is passing it to a third party without the priorpermission of the sender. =

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Yes its an interesting time we keep being reassured about the long term and

sustainability post 2015 but I am not so sure.

I am doing a very small piece of work commissioned by yorks and humber DCS's to

consider post 2015 and how well LA children's services are prepared and

understand the commissioning of health visiting and school nursing.

Its hoped the work will identify themes that may be taken forward to ensure the

structures and processes area well thought through at strategic level across

Partners but also a real understanding of how that is translated to front line

staff.

Will keep you informed

Liz

Sent using BlackBerry® from Orange

Re: Numbers of visits

Hi Senate Members

I have been following the conversations but think the focus should be on how

much time is actually spent with the client. I could complete 2 visits and spend

4 - 5 hours of my day wit h clients especially if they are in crisis and need

interventions fro m other services. I work in a very deprived area in East

London. Sometimes I go to a client to follow up a Police Merlin report. Often

this is the first contact the family has with the HV service as we serve a very

mobile population. The client discloses severe domestic abuse because they are

scared to report it to the Police and you have to start making referrals from

the client's home. On other days I complete more visits, up to 5 but spend less

time with clients as I spend more time travelling and record keeping.

It's important to measure what we do and what difference we make. But I don't

feel the number of visits we undertake is an accurate measure of what we do. I

feel that the time spent with the client intervening early or managing a crisis

to prevent it from escalating is more important.

Where I work we use EMIS web to record activity - the actual time spent with/on

the client - face to face time, telephone contacts, liaison, data entry, etc. We

also record outcomes - what difference we actually make. I'm concerned that

counting the number of visits we do does not really demonstrate the value of the

great work we do with our clients. And doing more visits does not necessarily

mean that we make a difference to more people.

Regards

Ruth Oshikanlu

Sent from my iPhone

On 20 Jun 2012, at 09:29, Cheryll

<cheryllma@...<mailto:cheryllma@...>> wrote:

I wo nder whether Senate members can help me? I have been asked how many visits

HVs do daily these days, and the average per week. As I understand it the

introduction of systems such as Rio, corporate working necessitating often long

journeys from base, the scale of child protection and other factors have

sometimes reduced these quite significantly. A health visitor recently told me

it was often as low as 2 a day due to the amount of travel time, report writing

and time spent on data entry – is this typical? Consider a day without clinics

or other meetings.

Clearly there will be huge variability up and down the country, but can you help

me with a straw poll by telling me the rough figures where you work?

Many thanks

Cheryll

The information contained in this email message and any attachments is

confidential and is intended for the named recipient only. If you have received

this message in error, please destroy it and notify the sender immediately. The

unauthorised use, disclosure, copying, or alteration of this message is strictly

forbidden, as is passing it to a third party without the prior permission of the

sender.

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Hi CherylIn Warwickshire it is an average of 6 home visits a day Theresa Sent from my iPhoneOn 20 Jun 2012, at 09:29, Cheryll <cheryllma@...> wrote:

I wonder whether Senate members can help me? I have been asked how many visits HVs do daily these days, and the average per week. As I understand it the introduction of systems such as Rio, corporate working necessitating often long journeys from base, the scale of child protection and other factors have sometimes reduced these quite significantly. A health visitor recently told me it was often as low as 2 a day due to the amount of travel time, report writing and time spent on data entry – is this typical? Consider a day without clinics or other meetings.Clearly there will be huge variability up and down the country, but can you help me with a straw poll by telling me the rough figures where you work? Many thanksCheryll The information contained in this email message and any attachments is

confidential and is intended for the named recipient only. If you have received

this message in error, please destroy it and notify the sender immediately. The

unauthorised use, disclosure, copying, or alteration of this message is

strictly forbidden, as is passing it to a third party without the prior

permission of the sender.

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