6th December 2017
- More than 1 in 3 health visitors worry that they are so stretched that there may be a tragedy in their area at some point
- More than 1 in 5 health visitors are working with caseloads of over 500 children
Results from the Institute of Health Visiting (iHV) annual survey 2017 show the worrying impact of a reduction in health visiting services on babies and families since responsibility for the service in England moved from the NHS to cash-strapped local authorities in October 2015.
This year’s iHV survey of over 1400 health visitors shows major concerns around safeguarding and protecting children at risk, with a third of health visitors in England feeling that they are so stretched that there may be a tragedy in their area at some point – this is up from 25% in 2015 and strongly suggests a very unsafe situation for both children and health visitors who must manage that risk and worry, and know they may be blamed if a child is injured.
The survey also disturbingly showed that more than 1 in 5 (21%) health visitors in 2017 are working with caseloads of over 500 children – which is in stark contrast to the 1 in 8 (12%) reported in the iHV survey in 2015 when the funding transferred from NHS to local government, and when a recommended ‘minimum floor’ was set of three whole time equivalent health visitors to cover 1000 children. The Institute recommends an average of one health visitor to 250 children to deliver comprehensive health improvement.
42% of those surveyed reported they can only offer continuity of care to vulnerable children and those subject to child protection processes (26% in 2015). This is worrying when it’s the ability of health visitors to build a trusting relationship with families over time that gives those families the confidence to disclose sensitive areas where they need help promptly.
Dr Cheryll Adams CBE, executive director of the Institute of Health Visiting, commented:
“Health visitors are advanced specialist practitioners, previously nurses or midwives, who are very skilled at working with families to support them through stressful times.
“We are being told that many families see a health visitor only until their child is 8 weeks old, with less skilled staff carrying out all their later developmental reviews. Health visitors’ time is being targeted to picking up work once done by social workers in some areas of the country, meaning that these health visitors are not able to deliver their primary preventative role – the only professionals previously able to offer this as a universal service.
“Without a universal preventative service many children and families in need will be missed until their problems become serious, which goes completely against the role and responsibilities of a trained health visitor and where they can have their greatest impact. Our worry is that the number of children needing care proceedings will increase, even more children will need mental health services, postnatal depression will go undiagnosed, there will be greater demand on GPs and hospital services and more children will enter school less well prepared in terms of their social, emotional and communication skills. Cutting the public health workforce is a false economy.”
Dr Adams continued:
“There is a significant research base that demonstrates the importance of investment in the early years to reduce later costs by up to eight or nine times including the cost of social care, the NHS and criminal justice services*. As a nation, we cannot afford to not invest in our children – they are our future. There is already a large group of children and families who are affected by the recent reductions to public health budgets, and without new investment this number seems set to increase.”
* See the work of Nobel Prize winning economist James Heckman: https://heckmanequation.org/resource/the-heckman-curve/ and Masters et al (2017), Return on investment of public health interventions: a systematic review http://jech.bmj.com/content/71/8/827