Town & Country Planning, October 2007
A couple of months ago, I found myself using this column to debate the comparative advantages of the 450 and 468 buses near where I live in Crystal Palace.
There was, of course, a point to all this, and I hesitate to try the patience of any remaining readers further along these lines. But I have to confess that what I want to do now is make the same comparison between community midwives and health visitors.
I find myself thinking about these things – and the long-term implications for localism – because my household is now blessed with the pitter-patter of four tiny feet (and I don’t mean a dog). That is enough to make anyone a temporary expert in those aspects of British culture and government concerned with maternity and I feel like doing Mastermind on the subject.
I ought to say at the outset that both professions are doing extraordinary work in difficult circumstances and are dedicated and often rather wonderful people.
I find myself glowing with gratitude at the thought of the community midwives, their amazing energy and support, at all hours of the night, and their sheer ability to empower people at extreme moments in their lives.
So why, when I have gone through the long queue to extract some pearls of wisdom from the health visitors do I get the slight sense that I have been in the presence of the obstetrics branch of the Gestapo?
Why do I feel, when I take an innocent and apparently supportive call from them, asking if the baby has successfully filled his nappy after a long period without doing do, just a little nervous of the consequences if he hadn’t?
These are not unimportant questions. I am an occasionally confident member of the educated middle classes. I am relatively articulate, at least when I get some sleep. You can imagine the effect of their attitude of constant official disapproval – that I am failing to abide by every letter of Department of Health guidelines – on families who are less confidently middle class than me.
You can’t help noticing that this is a relatively perilous period to be a parent. Time after time in the press, you see the same pattern: professionals who are unable to solve or explain a problem with a child – whether they are doctors or police – end up blaming the parents. Often carting them off to prison.
But it is more than that. Community midwives are employed by local GP practices and you know, right from the start, that they are fully supportive and on your side. Health visitors clearly now regard themselves, a bit like school inspectors, as agents of a centralised state.
They regard themselves as enforcers of central government advice in all its bizarre peculiarities. They are therefore very much less effective than they ought to be.
My most recent experience with health visitors concerned goat’s milk, which anyone with any experience of asthma, allergies or eczema knows is a good deal healthier than cow’s milk. Yet when my wife let slip that we were feeding the two-year-old goat’s milk, the health visitor nearly had apoplexy, deeply disapproving on the grounds that there isn’t nearly as much calcium.
There is, in fact, just as much calcium, as the chief local health visitor confirmed. But she still read out the government guidelines discouraging goat’s milk on the grounds that there was very slightly less iron – as if one drank milk as a source of iron.
So this is a tale, once again, of the deeper consequences of centralisation. Central governments, and ours especially, very much prefer us not to take the initiative on anything very much – least of all to prevent the galloping spread of childhood eczema – without their full approval.
And while a respected profession like health visitors regard themselves as the agents of government advice in this way – rather than genuinely being on the side of individual parents – we can hardly be surprised if hard to reach families get even harder to reach.
The lesson here is about how we make our institutions effective. The truth is, at least supported by constant experience, that the more local our institutions are – the more owned they are by local people – then the more effective they are. This is, in fact, the central message of localism.
The difficulty is proving it with numbers. The task for localism, if it wants to stamp its mark on the Brown government – if we still have one of those by the time this column is published – is to find ways of proving this point in ways that even the Treasury can understand.
But then, even Treasury mandarins presumably find themselves in the slightly scary presence of health visitors occasionally.
David Boyle is the author of Authenticity and a fellow of the New Economics Foundation. www.david-boyle.co.uk