But they fear health authorities may block innovation and creativity.

Under the proposals, health visitors will give support to the whole family, not just the mother or baby.

They will be required to look out for danger signs in the parents' relationship and offer access to counselling or other services.

They will also be able to offer support for families for longer than the present few weeks after birth.

Pilot scheme

The Community Practitioners' and Health Visitors' Association (CPHVA) says the government's plans to strengthen the family will provide a significant boost for the role of health visitors.

The CPHVA says the proposals are based on a pilot scheme in Dorset where couples are offered counselling and parent education classes.

The counselling service is optional. It is offered if health visitors detect signs of problems after talking to parents, for example, post-natal depression.

Mary Daly of the CPHVA said health visitors were already trained along a socio-medical model which emphasised listening skills and health prevention by dealing with the causes of illness.

With extra training, they could develop these skills to address family and community issues which influence the health of children, she said.

"In the 1970s, we had the concept of mother and baby. In the 1980s, the focus was on children on their own and there were children's services instead of family services.

"The government is now saying that children live in families which may have one or two parents who live in communities. If we support the family and the community then children will benefit."

Trustworthy

She said health visitors were seen by the government as being trusted by many people.

Health services in the 1980s focused on the child rather than the family

"The government realises messengers are as important as the message. People are more receptive to messages if they trust the messenger," she stated.

However, she was worried that health authorities and trusts might not support health visitors in developing innovative ways of supporting families.

"There is still very much a competitive culture in the NHS and it is terribly bureaucratic," she said.

"It is very, very difficult for creative workers to work in that climate. There is little evidence that health authorities are capable of providing joined up thinking for health. They are still talking about children's services, for example."

She said trusts and authorities constantly wanted statistics and paperwork, which she called "tick-sheet health visiting".

Flexibility

She wanted the service to be more flexible, with health visitors, for example, having more power to decide how often they visit families.

"Health visitors feel uncomfortable dancing on the doorsteps of people who don't need them," she said.

She added that many health visitors felt frustrated that they spent all their time identifying needs and not enough time addressing them.

Many were "crawling up to 55" and feeling burnt out. The CPHVA was looking with the government at ways to retain them in the service, such as reducing paperwork.

Not just money

The CPHVA believes the Green Paper's emphasis on giving parents and health visitors more power to decide when intervention should end will allow more flexibility.

It marks a return to the 1970s system where health visitors continued to work with families as long as was deemed necessary by both parties.

Health visitors were recently given an extra £1m by the government. The CPHVA hopes there will be more money for the service in order to help train more staff.

The Green Paper on the family acknowledges the need for more health visitors after years of cutbacks.

But Mary Daly said it was not just extra money that was needed.