11th September 2020
A Voices blog by Alison Morton, Director of Policy at the Institute of Health Visiting, on our latest publication – “Making History: health visiting during COVID-19”.
Yesterday, the Institute of Health Visiting (iHV) published “Making History: health visiting during COVID-19” which presents a window into the working lives of health visitors and families navigating the ups and downs of the COVID-19 pandemic. It has taken a global public health pandemic to shine a spotlight on the importance of the health visiting service, providing a vital universal “safety net” for babies, young children and their families.
The work of health visitors is often hidden from sight which has made it an easy target for cuts during times of austerity. Over the last few years, the service has faced considerable challenges with year-on-year public health grant cuts and a depleted workforce.
Bang the drum for a strengthened health visiting service for all children
This publication is a “good news” story in a world which is dogged by criticism and blame. The case studies provide a glimpse of the “art of the possible” which can be achieved when these passionate and dedicated practitioners do what they do best – putting children and families first to give every child the best start in life. I am constantly told that “good news” stories never hit the headlines – with this challenge before us, I invite every health visitor and everyone who values health visiting to join with us and bang the drum for a strengthened health visiting service for all children.
In March the world “locked down” and health visiting services were partially stopped and adapted to a socially distanced way of working. Yet many aspects of the world did not stop – babies kept being born and the normal struggles of parenthood became amplified for many. Some families enjoyed the relative peace of an enforced slower pace of life; however, most families were negatively impacted by lockdown and home was not a safe place for some, and rates of domestic violence and abuse, mental health problems and safeguarding concerns quickly became a source of concern.
Health visiting skills needed more than ever
During the last few months, parents have reached out to health visitors for support as many other sources of support were no longer available. The breadth of skills that health visitors have as Specialist Community Public Health Nurses, supporting babies, young children and their families during the biggest public health emergency in living memory, have been needed more than ever.
The case studies, family stories and creative pieces contained within “Making History: Health visiting during COVID-19” capture the pace and scale of change and health visitors’ leadership skills driving rapid service transformation. Health visitors have risen to this challenge with professionalism and autonomy, flexing and developing innovative service “workarounds” to ensure that families receive the best possible support. Different areas have responded in different ways, many introducing “virtual” contacts and group support instead of face-to-face contacts, as well as rapidly responding to urgent needs supporting families using Personal Protective Equipment.
Call for “Nightingale effort” for our country’s children
Whilst we celebrate the achievements of health visitors, there is also more that needs to be done to strengthen the health visiting service. Underinvestment in health visiting is a longstanding concern and the service was already significantly depleted when it entered the pandemic. It then faced considerable challenges as large numbers of health visitors were redeployed into hospital and community settings to treat patients as part of the NHS emergency response. In some areas, more than 50% of the health visiting workforce were redeployed into other settings. As a result, many families have not received the support that they needed during this time and there are concerns that the needs of vulnerable babies and young children may remain invisible.
We support the call of the Children’s Commissioner for a “Nightingale effort” to be focused on our country’s children. All efforts to target support to those in greatest need will only work if there is an effective universal service to identify vulnerable children and their families.
We call on the Government to invest in health visiting as a matter of urgency and reverse the cuts that have significantly depleted this vital universal service in recent years. We need to learn from COVID-19 and the experiences of families and health visitors to ensure that the health visiting service is strengthened and fit to face the challenges that lie ahead as we adapt to living with the virus for the foreseeable future. The challenges that we face are not insurmountable, individually and collectively we have the ability to put things right. But this requires bold action to make the difference – there is no time to waste, the time to act is now.
Our recommendations for restoration of the health visiting service are:
- Health visiting services should be reinstated (where they have not been) as a matter of urgency as a vital support and safety-net for children, with appropriate measures put in place, including the use of PPE, to reduce the spread of the virus.
- Health visiting services must be fully prepared for any future waves of COVID-19. NHS England should revise the Community Prioritisation Plan (for phase one pandemic management) and develop clear messages on the importance of continuation of the service to ensure the needs of children are prioritised. This should include removing wording on the redeployment of health visitors.
- A clear workforce plan is needed to ensure that the service has sufficient surge capacity to manage the backlog of missed appointments, as well as demand for support due to the secondary impacts of the pandemic.
- An evaluation of the use of virtual, non face-to-face service delivery methods is urgently needed to determine their effectiveness for identification of vulnerabilities and risks, impact on child and family outcomes and reducing inequalities to inform future digital change.
- A cross-government strategy is needed to reduce inequalities and “level-up” our society – this will require investment to strengthen the health visiting service which plays a crucial role in the early identification and support of the most disadvantaged families.
- The impact of working during the COVID-19 pandemic on staff wellbeing cannot be underestimated – a proactive plan is needed to ensure staff have the right support during the restoration of services and to create high quality workplaces for all staff in the future.