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Collective system failure puts vulnerable children at risk

6th July 2021

Originally published 1 July 2021

Joint letters from the Institute of Health Visiting (iHV) and the School and Public Health Nurses Association (SAPHNA) warn national and local leaders that the proposed cuts to health visiting and school nursing services in Hampshire will put children at risk of harm.

Despite rising levels of safeguarding concerns nationally which saw 285 children killed or seriously harmed in the first 6 months of lockdown in England, Hampshire County Council has forged ahead with their plans to cut their health visiting and school nursing services intended to support families and safeguard children.

Concerns have been raised that the proposals described as “Serving Hampshire, balancing the budget” bear no resemblance to the national Healthy Child Programme which sets out a programme of support for all babies, children, and their families. Within the proposed plans to reduce the 0-19 Public Health Nursing Service budget by £2.09 million per year are significant elements that will undermine delivery of the Healthy Child Programme, drastically cut the support available to families, and strip out the mechanism to identify vulnerable children:

  • cutting approximately 47 staff posts (12.5% of the current workforce);
  • for children 0-5 years, all children will only receive one mandated face-to-face health review. All other reviews will be risk assessed to decide whether they should be completed face-to-face, by video or by telephone”;
  • only providing school nurse support to children and young people over the age of 11 years through the digital offer’, i.e. NO face-to-face service;
  • minimal school nursing statutory involvement in safeguarding and child protection.

The whole health and social care system is interconnected and changes like these cannot be made in isolation without consideration of the wider system impact; making radical cuts like these will cause harm to children and will create a ripple effect across other services like GPs, secondary care, and children’s social care that are already stretched and need to be accounted for.

The iHV and SAPHNA believe there are several sets of grounds which, singly and severally, mean the County Council and national government ought to review these plans, to ensure that they are not in breach of their statutory safeguarding responsibilities nor undermine the delivery of the Healthy Child Programme which has been mandated by government.

Post-covid, it is even more important that families with babies and children are supported, with rising levels of children living with vulnerability and risk. England already has a significant problem, with 1/3 of all vulnerable children recognised as ‘invisible’ [1] within the system and therefore not receiving the support that they need. Our children are also the unhappiest across Europe. This proposed model would place them at even greater risk

These cuts are the predicted consequences of insufficient funding and inadequate system levers, alongside a lack of prioritisation of prevention and early intervention at all levels. An urgent national review is needed to acknowledge the root cause of these cuts, and their significant wider system impacts, with a clear plan to tackle them once and for all.

Sharon White, CEO SAPHNA, said:

“We have seen a number of recent and significant cuts to health visiting and school nursing services with more planned; this must stop. We are fully versed in the Governments budget cuts, reduced public health grant and cash-strapped councils with our services clearly seen as ‘easy pickings’ in trying to rectify; this false economy as only serves to kick the can down the road, resulting in increased costs to services to say nothing of the long-term impacts on children’s and families’ lives.

We have more than enough evidence to demonstrate that our public health practice can and does make a vital difference. Hampshire’s proposals are radical, dangerous and a disservice to its population. We cannot and must not accept this.”

 Alison Morton, Executive Director at the Institute of Health Visiting, said:

“We should all be worried about what’s happening in Hampshire. The proposed changes in Hampshire represent an important national test case, rather than an isolated outlier that only needs to be addressed locally. The national Government’s response is that it’s down to local authorities to decide how they manage their budgets. Conversely, the local authorities’ perspective is that the cuts are due to a lack of government funding. Both are true – and the time has come to move beyond this stalemate and find a sustainable solution that puts babies, children, and their families first. Unless resolved, families ultimately bear the brunt of these cuts.”

The council is seeking residents’ and stakeholders’ views on their proposals through an open consultation process. We urge as many people as possible to “have your say” by responding to this consultation. The consultation Information Pack provides further detail about Public Health services in Hampshire, the four areas under consideration and the options for change – available here.

The iHV response: Since the consultation was launched, the iHV has been working constructively and in collaboration with the School and Public Health Nurses Association, the unions, and colleagues in Hampshire County Council to find a resolution that meets the needs of babies, children, and their families. At the end of last week, the iHV and SAPHNA sent a joint letter to both Hampshire County Council and Public Health England outlining their concerns.

Serious Incident Notifications: The total number of serious incident notifications for children during the first half of 2020-21 increased by 27% (n=285) on the same period in 2019-20 – of these, 35.8% relate to under 1s who remain at the highest risk of homicide than any other age group[2].


2 BETA: .GOV.UK (2021) Part 1 (April to September) 2020-21. Serious incident notifications



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