THE NHS RECRUITMENT GAP: a special investigation by Marlborough News Online - Part Two: the government's pledge on extra health visitors
One of the health service pledges made by the coalition - and much-heralded by coalition MPs - was to increase the number of NHS health visitors in England by 4,200 before the end of March 2015.
On January 30 the Department of Health gave Marlborough News Online a statement: "The most recent figures held by NHS England show that there are 3,218 more health visitors than in 2010."
The statement went on: "The expansion of the Health Visitor workforce has been one of the most rapid and successful in NHS history." If they recruit the extra 918 health visitors before the end of March, we can be sure of a mighty media blitz trumpeting the achievement. But they are not expected to reach the promised figure - so there may instead be a resounding silence.
In 2011 the Department of Health set up a Health Visitor Taskforce, drew up an implementation plan and for a while six monthly reports were issued on its progress towards the target.
The one for October 2013 to March 2014 stated that by the end of the financial year 2013-2014 the increase in the number of health visitors over the baseline 2010 figure was 2,291 (in terms of 'full time equivalent' posts.) That was an increase of 28 per cent.
Then the reports stopped. This may have been something to do with the fact that the implementation became split - or shared - between the Department of Health and NHS England.
Meanwhile, NHS England went on a recruitment drive seeking health visitors from Ireland and from Denmark.
Denmark was targeted because their training for a health visitor ('sundhedsplejerke') is similar to UK training and recruits were unlikely to have difficulties passing English language tests.
It is said NHS England wanted to recruit 200 Danish health visitors - especially to shore up the very low increase in health visitors for the London area. This time last year a group of Danish health visitors was brought over by the East London hospital trust to learn more about health visiting in England.
The advertisement NHS England used in Ireland asked: "Interested in a career where you give children the best start in life? Looking for an opportunity to work overseas and fully use your skills? if so, then health visiting in England could be for you."
"Roles are available in London, the North and the Midlands in some of England's fastest growing cities such as Manchester and Birmingham - ideal locations for a thriving career." Interested people could email their "expression of interest for working in England and we will follow-up with you directly." And there was an "on-line application process".
Apart from spending money on expensive advertisements, the Department of Health had to hand all the levers of change to make sure the pledge was achieved. They were able to increase the number of training places for health visitors by 500 per cent since May 2010. And still the rate of increase in the numbers of extra health visitors has been for government ministers nail-bitingly slow.
Imagine the smile on the face of the Chief Exec of a major English hospital trust if you told them they could simply up the number of training places for nurses by 500 per cent.
In part the problem the pledge has hit is that the number of people in England who want to work in health care is limited. So this kind of high pressure recruiting drive can end up robbing Peter to pay your pledge.
Since 2013 Great Western Hospitals have lost five midwives who decided to become health visitors: "After all, midwives like working with babies, so why not become a health visitor." From NHS England's point of view they are 'low hanging fruit' as midwives only need a one year course to become health visitors.
With government money behind this pledge and all the necessary levers of change to hand, it has still not been a straightforward and easily successful recruitment drive - and it may yet fail.
How much harder it is to recruit locally when you are at the mercy of policy decisions from central government and its many agencies. And also at the mercy of those parts of the press which want the NHS nursing profession to be restricted to 'English angels' - speaking the Queen's English and as dedicated as Florence Nightingale.