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Time to leave redeployments and return to the health visiting front line

6th June 2020

A Voices blog by Dr Cheryll Adams CBE, Executive Director at the Institute of Health Visiting.

Dr Cheryll Adams CBE, Executive Director of iHV

There was jubilation in the iHV staff offices (all home based) this week when we finally had it in writing that health visitors should no longer be redeployed and should be returning to their health visiting roles. We had secured support from NHS England and Public Health England some weeks ago for health visitors to be returned to their own front line where there are so many new COVID-19 related needs. This had been cascaded through the NHS, but still we were hearing of far too many health visitors and their teams in NHS nursing or support roles, often with not enough to do. Community nursery nurses (CNNs), who are trained in  child development and play, were also quite traumatised to find themselves now expected to work with dying adult and elderly patients.  This is a privilege to a nurse, but not what CNNs had signed up for. Many health visitors were stressed and traumatised too as they found themselves having to embrace roles which they had had no experience of, or recent training for, whilst also knowing that now there was no one with the expertise to support the vulnerable families whom they had left behind.

As we reflect back on the decisions made to redeploy health visitors in the earliest weeks of the pandemic, we are now able to weigh them with the benefit of hindsight. As all efforts were focused on treating infected patients, the needs of children and families were overlooked – this was a mistake and the redeployment of health visitors should never have happened. Health visitors are an essential part of the country’s support structure for children and their parents during this public health pandemic, and their redeployment has left many families without the vital support that they need. Whilst not keen to dwell too much on how the redeployment of health visitors has been handled, I do want to put on record how poorly handled it was in some areas with the appeals of those being redeployed going unheard. We are told that only volunteers should have been redeployed, however this was certainly not the case for many health visitors and CNNs.  We have heard of health visitors and their teams being given as little as two hours notice of redeployments that they hadn’t volunteered for, and hence no time to organise support for the vulnerable families left behind.

We heard of health visitors leaving behind caseloads with high safeguarding need to be told to pick up band 3 clerical jobs, or band 3/4 support roles, often being moved to roles where it was clear that they weren’t actually needed, whilst leaving behind so much hidden and conspicuous need.

Prior to the COVID-19 pandemic, health inequalities and poverty in the UK were in a very bad place, how much worse must they be now with the new levels of unemployment, increased parental mental health problems, domestic violence and abuse and the wider effects of prolonged lockdown? The greatest impact will be on the most vulnerable members of society – babies. These families need help and the only universal service available to respond is/was health visiting.

Achieving a safe response has been hard enough whilst avoiding cross infection, but health visitors are very creative, and those not redeployed have demonstrated their leadership skills when faced with enormous service delivery challenges. They have quickly adapted with innovative solutions that placed the needs of children and families at the centre; developing a range of creative online (video, text, Whats App, Facetime) and face-to-face adaptation to ensure that families needing their service have some chance of getting it. They have offered telephone help-lines, online drop in clinics and virtual support groups, socially-distanced visiting in gardens and socially-distanced clinic appointments so anxious or vulnerable mothers could have their babies seen.

However helpful this has been, with so many less health visitors in their roles, it has been impossible for health visitors to look for hidden need, or even to respond promptly to every request for help. Many mothers have taken to online groups to report how difficult it has been to obtain help, and how anxious they have been and how difficult they have found the lockdown period.  There is absolutely no doubt that, despite the best efforts of the health visitors left in post, it was inevitable that hidden need would be missed. In one area, health visitors reported that their caseloads had soared to 2,400 children when the optimum maximum is 250 children. The fallout became more obvious when there was national alarm because referrals of babies to our three national centres for liver disease dried up over a three-week period, immunisation rates started to plummet and, when parents started to return to A&E, they were presenting with conditions that would normally have been managed by health visitors – for example concerns about infant crying or breastfeeding difficulties.

I really hope that there is a national inquiry into the redeployment of health visitors so that there is learning from this for the future. We need to ensure that we are better prepared next time. It is not only the conspicuously sick who have needs – getting it wrong in the first years of life can create lifelong impacts for individuals as well as leading to lifelong use of precious NHS and other services, and will further impact on health inequalities. I never again want the iHV to receive so many emails and messages from distressed health visitors worried about their vulnerable families and feeling helpless and unheard as they are told, not asked, to take on alternative nursing or clerical duties.

Learning from the past must inform the future – the key contribution of health visitors in promoting the health and wellbeing of families must now receive the attention it deserves as we enter the rebuilding phase of the pandemic. Prior to COVID-19, the Institute was calling for investment into the service, into training more health visitors, and into addressing the significant variation in services across England by ensuring a quality service for all children (see our Vision). This is now even more urgent.

We need a clear plan to ensure that health visitors are equipped to manage the backlog of missed appointments, as well as the increase in demand for support due to rising numbers of vulnerable children and families.

This will not happen by chance – the planning needs to start now with the same concerted effort that focused on building Nightingale hospitals and treating infected patients. Our children deserve better next time – will this opportunity for learning be wasted? Let’s hope not. Join us on our journey.

Dr Cheryll Adams CBE, Executive Director, Institute of Health Visiting

If you have still not been given a date to return from redeployment please contact us at [email protected], and tell us where you work, or contact your union.

If you are a health visitor, community staff nurse or community nursery nurse feeling distressed from the events of the past 10 weeks, there are really excellent NHS staff resources to help you – look under the “Practitioner health and wellbeing” dropdown section on https://iHV.org.uk/COVID-19Please look after yourselves.