The Institute of Health Visiting (iHV) publishes its findings from the largest survey of health visitors working with families with babies and young children across the UK – “State of Health Visiting, UK Survey Report – From disparity to opportunity: The case for rebuilding health visiting”.
Our survey, now in its 11th year, gathers valuable intelligence from health visiting practitioners across the UK who see the realities of family life and the challenges currently being faced by so many families with babies and young children. The findings highlight a stark increase in complex needs among families, coupled with a severe shortage of health visitors and significant disparities in service provision.
Key Findings:
- Rising Needs: Families are facing increasingly complex health and developmental challenges, yet the support they need is becoming harder to access.
- Service Gaps: There are massive differences in the availability of health visitor services across the UK, creating a postcode lottery that leaves many families without essential early support that can make such a big difference.
- Workforce Strain: Health visitors are under immense pressure, with unmanageable workloads, enormous caseloads and a longstanding workforce crisis that is threatening the sustainability of services.
The report underscores the urgent need for government intervention to address these critical issues. Without immediate action to increase the number of health visitors, the health and wellbeing of countless families and children are at risk.
The Government has committed to change the trajectory to raise the ‘healthiest generation of children ever’, ‘strengthen health visiting’, and shift the dial from ‘sickness to prevention’. There is a clear imperative to act now for the benefit of all babies, children and families, but there is much work to be done to achieve this.
- 84% of practitioners reported that the demand for health visiting support had increased over the last 12 months; however, the workforce has not kept pace with the increasing needs and practitioners reported falling health visitor numbers across all UK nations.
- Families want personalised care. But only 45% of health visitors in England are able to provide continuity of carer to families “all or most of the time” compared to 90% in Scotland, 86% in Northern Ireland and 85% in Wales.
- In England, demand for health visiting support is currently far in excess of what services are commissioned and able to provide; 73% of health visitors said workforce shortages impacted on their ability to support families when a need was identified.
The increased demand by families for health visiting support over the last 12 months is for multiple reasons, with perinatal mental health problems being the top reason across the UK. Practitioners have also seen soaring demand for support for:
- Child behaviour problems, including growing concerns about neurodevelopmental issues like autism and ADHD that need to be taken seriously (and were ranked as the 2nd highest reason why families needed extra help from health visitors in Scotland, Wales and Northern Ireland).
- In contrast, practitioners in England said that their practice was dominated by social concerns; with more families needing help with the impacts of poverty and with babies/children who have safeguarding concerns below the threshold for Children’s Social Care.
Practitioners reported unacceptably high rates of work-related stress due to the nature of their work, as well as the trauma of being the frontline practitioner who must tell families that they cannot provide the care that they need due to a “broken NHS”.
Alison Morton, iHV CEO said:
“The report highlights the urgent need for investment in health visiting services. Health visitors want to deliver high-quality, personalised, and equitable healthcare to all families – but this cannot remain a “hope” that is limited to words in the pages of policy. We need to get the basics right and this requires action to rebuild the health visiting workforce that has been cut beyond the bone in too many areas.
“The needs of babies, children and families must lie at the heart of all service transformation – currently too many have been left waiting too long without the support that they need, which we know can make such a big difference to their outcomes. Failing to act is a false economy. Childhood matters because it is short – there is no time to lose, the devastating impacts of not intervening are well known and have both a human and economic cost.
“Whilst the current picture is bleak, we remain optimistic for a better future. The findings demonstrate that, despite the current challenges and unacceptable disparities in healthcare, change is possible. The health visiting workforce is ready, willing and able to play its part to halt the decline and rebuild, to ensure that the UK has a world-class health visiting service so every baby can have the best start in life.”
The survey findings position health visiting as a safety-critical workforce, essential to safeguarding and improving outcomes for babies, children and families.
The survey findings are presented in four themed sections:
I. Babies, young children and their families’ needs – including child health, development and safety
II. Health visiting services, responding to need across the UK: widening disparities
III. Health visiting workforce matters
IV. Strengthening health visiting – train, retain, reform.
We’re calling for the following key changes:
- Funding – A realistic and accurate level of funding that reflects the true scale of need for health visiting services. Adequate resourcing will ensure:
i. Accessible Services: Expanded reach of health visiting services to all families, particularly those in underserved communities.
ii. Increased Workforce: Recruitment and retention of skilled health visitors to manage appropriate caseloads.
iii. Enhanced Training: Continuous professional development to equip health visitors with up-to-date knowledge and skills to drive high-quality care.
iv. Strengthened health visiting services: Maximise the role of health visitors to reduce pressures in the NHS through a shift to the community and an increased focus on prevention, improving immunisation uptake, and reducing disparities in antenatal and postnatal healthcare.Long-term investment will help services to plan and build world-class services, ending the uncertainty of short funding cycles.
- Workforce – Train, retain and reform the health visiting workforce across the UK
i. In England specifically: To deliver the national long-term workforce plan in full, ensure accurate workforce forecasting to meet the scale of need; and, in line with other UK nations, develop a robust, evidence-based safer staffing tool to ensure safe and effective care. - Quality – National government must do more to end the current postcode lottery of health visiting support:
i. The needs of babies, children and families must be at the centre of healthcare delivery, with system blockers removed to enable best practice and integrated healthcare.
ii. All areas must provide health visiting services that reflect best practice, and are proportionate to the scale of need, with mechanisms to hold failing areas to account. (In England, the Commissioning Guidance needs strengthening with explicit governance to reduce disparities and drive high-quality healthcare).
iii. “Health” must remain a central component of health visiting to enable health visitors to play their fullest part in improving health and reducing inequalities for babies, children and families.
iv. Health visiting research, workforce development and the sharing of evidence-driven models of best practice are supported.
To cite this report, please use the link to the pdf here: https://bit.ly/4hmR3Me
