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  3. A Day In The Life Of... Hannah Spiring (Health Visitor)

A Day In The Life Of... Hannah Spiring (Health Visitor)

"I enjoy it when I see that what I am doing is making a difference."

Please give a brief overview of your background

I was born in Clacton-on-sea in Essex and came to London in 1992 to train as a nurse, with a plan to move home after I qualified. However, I met my husband whilst training as a nurse and we have remained in London ever since. We have two children, the oldest is in Brighton in her first year at university and our son is sitting his GCSE exams this year. We both live and work in Tower Hamlets.

I qualified as a nurse in 1996 after completing the project 2000 course at St Bartholomew’s school of Nursing and Midwifery. I worked at the Old Royal London Hospital on a surgical ward for two years before moving to a medical ward in Homerton Hospital. At the end of 1998 my husband and I spent two months working in a hospital in South Africa. When we returned from South Africa I started to train as a midwife. I qualified in 2000 and worked at the Homerton Hospital in their community midwifery team for four years during which I gave birth to my daughter. After my son was born, I stopped working as a midwife and stayed at home with my children for three years. I then spent three years running a toddler group in a local church and taught on a parenting course.

In 2010 I decided to return to working as a midwife and completed a Return to Practice Midwifery course with the RCM and at the Royal London Hospital. Once I had completed the course, I started working at the Homerton again and after a year of rotating around the wards I moved out of the community and helped to set up a new team when the boundaries for maternity care were changed. I also spent six months working as a Public Health Midwife, similar to the Gateway Midwifery team in Tower Hamlets.

In 2015 I applied to train as a Health Visitor with City University and Barts Health, transferring to the GP Care Group in April 2016. I spent a year working in the South West and then when I qualified, I moved to the South East Locality in Tower Hamlets.

I have recently completed my Dissertation Module and will graduate with a Masters in Public Health in the Summer.

I cycle to work almost every day, only snow will stop me! I also try and go swimming on my day off on a Friday and I enjoy taking part in Parkrun at Mile End Park on a Saturday Morning, although my running is very slow!

I also enjoy cross stitch and have recently discovered stitch-along where you get just a small part of the pattern each month and stitch along with others in a group on social media.


What are the key aspects of your role?

Working with families under five years old, delivering the healthy child programme including six mandated contacts from Antenatal visits through to when the child is age two years for all families. I provide short term extra support for families who need this, and long-term support for those with children on Child protection or child in need plans. I also deliver the MECSH (Maternal Early Childhood Supported Home Visiting) programme to targeted families.


What team/service does your role sit within?

 My role sits within the 0-19 Health visiting service.


Name two other teams/services that you work closely with, and how?

I work closely with GPs, the Midwifery, and School Health teams. I liaise with Midwifery about women during pregnancy and postnatally to ensure good seamless care is provided. I work with School Health to hand over children from families who need extra support from school nurses when they transition at five years old. I also work with GPs to discuss the families registered with them that are under children’s social care or require extra support.


Describe a typical day in your role - what do you do?

There is no typical day in health visiting, each day varies. Some days I see families in our well child clinic for weight checks and health advice, other days I am running a review clinic for children age 3-4 months or 8-12 months or in partnership with the GP at 6-8 weeks. I also visit families at home for new birth visits, listening visits, or the MECSH programme.

Here is a run day of a day I had recently.

After sending my family off to work and school I head into Poplar on my bike. I often feel like Call the Midwife!

My first visit today is with a family whose baby is currently on a Child Protection Plan. There is a review conference happening next week and so I had to write a report detailing what service I have been providing the family, how I think they are engaging with health visiting and whether I think the child is still at risk. We share these reports with the family before submitting them to the Chair for the Conference at Children’s social care. Today I am visiting the family so the parents can read what I have written, and this gives them an opportunity to feedback and have their voices heard. These parents have engaged with the service and things are looking positive for them, and the plan may soon be stepped down to Child in Need plan. It has been good to see this family make changes and engage with health visiting to enable them to look after their new baby in a better way than they have their older child.

My next family are on the MECSH programme. MECSH provides visits and support to families from the antenatal period all the way until the child is two years of age. In the early weeks of life, the visits are weekly and then spread out as the child gets older. MECSH is about enabling parents to provide for their child despite what is going on around them. The programme recognises that the child is still going to grow and develop whether the home situation is perfect or not. By providing extra support and enabling families to adapt and self-regulate we are helping these children get the best start in life.

The family I am visiting have a five-month old baby girl, who is also on a child protection plan because her mother is a recovering drug addict who has had her previous children put into care. This time appears to be different; mum is on the reset programme and she is beginning to reduce her dose of methadone and will soon be completely off it. The mother is finding this hard, but she is in a better position than when she had her other two children. She has a new partner, and his family are also helping and support her during her recovery. The mother is determined to keep this child and you can see how much she loves and cares for her daughter by the way they look and interact with each other even at this young age.

She is enjoying the MECSH programme and has started taking her daughter to baby massage and sensory play at the children’s centre as well as following advice about talking and interacting with her child from some of the MECSH programme booklets. I’m hoping this family will also soon be stepped down to a Child in Need plan.

After this family I carry out an opportunistic visit to a family who are on a Child in Need plan. I am struggling to get hold of the family on the telephone and I haven’t seen the child for a few months. Although the child is now four years old he doesn’t attend nursery, which is the mother’s choice and she doesn’t take him to any children’s centre groups either. There is no answer at the door and so I plan to check her contact details with her social worker and if the number hasn’t changed, I will write a letter with an appointment time.

In the afternoon I am in the 6-8-week review clinic at the GP practice. The staff at the GP organise the appointments for this and the family are seen by the health visitor and GP in two appointments, depending on whether we are running to time this means the families are there for up to an hour. As a Health Visitor we weigh and measure the length of each baby and discuss their development with their parents. At six weeks we expect the baby to have developed a social smile, be following their parent’s movements with their eyes, looking towards lights, responding to familiar sounds and being startled by a loud noise. We also discuss relevant health promotion topics such as how to manage minor ailments in small babies, how to get in touch with a health professional, good websites for parenting advice including the local Care confidence website, when to get the immunisations done, attending baby stay and play groups at the children’s centre, keeping baby safe at home, and advising vitamin d supplement to breastfeeding mothers for them and babies, formula milk is fortified with vitamin d.

We also assess how feeding is going, whether by breast or formula milk reassuring parents that their child is getting enough by assessing their weight on a centile chart in the Red Book and we make sure parents are aware that milk is all baby needs until six months of age.  We do a basic examination of baby without their clothes on when they are being weighed, we also observe for any concerning marks because safeguarding children is always at the forefront of what we are doing. The GP completes a medical head to toe check making sure baby is developing as they should. We also discuss maternal and paternal mental wellbeing offering extra support as needed. If we see the mother on their own, we will also enquire about domestic abuse. This is a routine question we ask at all contacts to make sure the family are safe and to offer extra support as needed.

Each visit or contact is documented in the child’s Red Book, which is a Personal Health Care Record that the family keep and take to appointments, as well as health professionals documenting in it. The Red Book holds a record of the child’s immunisations and has important information for parents. We also document all our contacts on the electronic record on EMIS, so my day ends making sure everything is up to date on EMIS and with me looking at any emails that have come in and need following up.


What would you say are the most challenging aspects of your role? 

The most challenging things in my job is when children’s social care is involved and there is a prospect of the children being taken into care. I have experienced this once and found it hard not to blame myself for a parent having her children put into foster care. Thankfully we receive regular supervision and I was able to reflect on this incident and was reassured that there was nothing more I could do to prevent it from happening.


What do you enjoy most, or what are you most proud of in your job? 

I enjoy it when I see that what I am doing is making a difference, for example the positive changes to the MECSH family I spoke about earlier, who have engaged with the service and are making the changes needed for mother to stay with her baby.

Sometimes we receive reports from children’s social care and what is on paper looks horrific, but then you meet the family and you see they are already making changes. Seeing these children grow up in a loving family who have overcome what life has thrown at them, now have aspirations for their baby and for themselves in the future, is something I’m proud to witness.


Share one thing that your colleagues don’t know about you?

As a child and teenager, I played the trumpet and was part of a marching band. I’d love to get back playing the trumpet but it’s not the most sociable of instruments!