27th March 2026
iHV welcomes a new University College London (UCL) led study which highlights the substantial drop in the number of health visitors across England who are available to support new parents. This independent study reinforces our State of Health Visiting survey findings over the last few years and shares our concerns about the fall in health visitor numbers and its impact on babies, children, families and communities.
The study used Freedom of Information (FOI) requests covering 147 English local authorities, with up to 109 authorities providing workforce data by 2021 – with the researchers analysing health visiting workforce trends between 2016–2021.
Over this period, the number of health visitors (majority NHS Band 6) dropped by 21%. Although the number of Clinical Skill Mix Staff (primarily Band 4) rose by one third, this increase only partially compensated for the loss of qualified staff, resulting in an overall contraction of the workforce. The data showed, nearly eight in ten English local authorities saw a decline in the proportion of qualified health visitors within their teams during this period.
The FOI responses also revealed that caseloads have surpassed safe levels in 74% of local authorities. It is recommended that caseloads should not exceed 250 children per health visitor, but the study identifies some caseloads of over 1,000 children per caseload-holding staff member. Caseload pressures have been particularly pronounced in the most deprived local authorities.
The study’s authors estimate that meeting recommended caseloads would require a major expansion of the health visiting workforce, with around 3,100 additional staff needed across all English Local Authorities under a 50:50 mix of Health Visitors and Clinical Skill Mix Staff (based on the mid-2024 under-5 population). They further estimate that restoring caseloads to recommended levels would cost approximately £120 million per year in additional wages (using NHS 2024/25 Agenda for Change pay scales), plus around £80 million in one-off training costs. The authors note that these sums are feasible within the scale of recent early years funding commitments – for example, the Family Hubs and Start for Life Programme (around £330.45 million across 2022–25, plus £126 million in 2025–26) and the Best Start Family Hubs expansion (over £500 million between 2026 and 2029).
The government cite ‘giving children the best start in life’ as one of their key missions, but this study shows that health visiting teams have experienced sustained funding cuts in recent years, with local authority spending on universal health visiting falling by almost 20% in real terms between 2016-17 and 2023-24.
This UCL-led analysis comes as the Department of Health and Social Care published updated Healthy Child Programme commissioning and delivery guidance on 6 February 2026, setting out a national framework for child and family health.
Lead author Professor Gabriella Conti (UCL Economics, UCL Social Research Institute and Institute for Fiscal Studies) said:
“What happens in the first five years of life shapes health and opportunity for decades. Health visiting teams are on the front line of that work – they support new parents, spot problems early and help prevent health inequalities from becoming entrenched.”
The researchers undertook this study on the state of the health visiting workforce after identifying a gap in workforce data since public health services for children aged 0-5 were devolved to local authorities in 2015, which hindered a robust evaluation of the effectiveness of the health visiting workforce.
Professor Conti said:
“Without robust data on the health visiting workforce, policymakers and researchers cannot properly understand workforce pressures, service gaps or where investment is most needed. The updated Healthy Child Programme is a welcome move towards more consistent provision across England. But unless it is matched by a national workforce restoration plan, families will go on experiencing big differences in the support available where they live.”
