Yesterday’s budget provides some welcome investment in the NHS, social care and education. However, a quick search for the terms ‘children’, ‘babies’, ‘prevention’ or ‘early intervention’ will leave you disappointed. We know that the country faces a tight fiscal settlement – money is tight. But are we spending our money on what matters?

The autumn budget misses the mark and is focused on firefighting. The settlement is presented as sound economics in the ‘here and now’. However, our children will not thank us for failing to grasp the evidence on prevention and early intervention. We have more evidence than any other generation that the foundations for future health and wellbeing are laid in the earliest years of life. It therefore follows that ‘smart economics’ will ensure that spending on babies, children and young people is front-loaded in any fiscal settlement and seen as the smart investment that it is, rather than a cost.

Failing to invest in the public health budget at a time when inequalities are widening, preventable deaths in children are increasing, and 1 in 3 vulnerable children are not known to services, is short sighted and will end up costing much more in the long run. Public health has been at the bottom of the list for investment for too long and this is undermining the Government’s ambition to improve the nation’s health and reduce the long-term burden on the NHS and adult social care.

Health visitors and school nurses working in local government play a pivotal role in ensuring all children get the best possible start in life and can thrive throughout their school years. Their work includes both prevention and direct support for babies, children, young people and families for a range of health needs, and often during times of great distress.

Failing to invest in these services will lead to significant pressures and reductions in capacity across the country. Where services are reduced or cut, this will have a real impact on families, babies and children, and many will be left without the support they need.

The public health grant has already been cut by 24% on a real terms per person basis since 2015/16. There is nothing left to cut. Health visitor and school nurse numbers are continuing to decline without additional investment, whilst pressure grows for both professions as demand continues to soar.

Further investment is urgently needed to enable councils to develop strong and innovative health visiting and school nursing teams in their local areas. Increased funding in this area will protect and support parents, babies and children so they can achieve the best possible outcomes.

Key headlines relevant to babies, children and families:

NHS funding – The government is providing additional funding of £3.3 billion in each of the next 2 years to support the NHS in England in response to the significant financial pressures it faces, and enabling rapid action to improve emergency, elective and primary care performance. There is no mention of public health.

NHS workforce plan – The government is publishing a comprehensive NHS workforce plan, including independently verified workforce forecasts, next year. This will include measures to make the best use of training to get doctors, nurses and allied health professionals into the workforce, increase workforce productivity and retention. At face value, this offers nothing for staff working in public health – we are awaiting confirmation.

Maternity services – The government is bolstering maternity services by meeting recommendations supported by the Ockenden Review for 2,000 more midwives. This is welcome news for maternity services but fails to tackle the national shortage of more than 5,000 health visitors who have a significant role to play in improving pregnancy outcomes and supporting safer postnatal care.

Children’s Social Care – £1.3 billion in 2023-24 and £1.9 billion in 2024-25 will be distributed to local authorities through the Social Care Grant for adult and children’s social care. This much needed investment is welcomed, but any efforts to improve outcomes for our most vulnerable children, and reduce the risks of harm, will also require a strengthened ‘upstream’ approach through preventative public health and early intervention services.

Schools – The government has committed to, “redouble its commitment to support schools, enabling school leaders to continue investing in the areas that positively impact educational attainment”. The core schools’ budget in England will receive an additional £2.3 billion of funding in 2023-24 and £2.3 billion in 2024-25.

From a school nursing perspective, whilst investment in schools is welcomed, the link between attainment and good health cannot be ignored. Without a parallel investment into school nursing to improve the worsening outcomes for so many school-aged children, this is somewhat futile.

Similarly, for health visiting, it is also disappointing to see that there is no similar commitment to the first five years of a child’s life, despite compelling evidence that the early years are vital for social mobility as this is where gaps in outcomes first begin to take hold.


Alison Morton                                           Sharon White
Executive Director                                    CEO
Institute of Health Visiting                      School and Public Health Nurses Association

#BuildBackChildhood #ChildrenAtTheHeart

As part of the Health Policy Influencing Group, the iHV is delighted to support the National Children’s Bureau (NCB) with the vision to #BuildBackChildhood which harnesses the support of over 700 organisations demanding that the Chancellor makes a strategic investment in babies, children, young people and families at the autumn Spending Review.  It is the latest action in the high-profile Children at the Heart movement, coordinated by the National Children’s Bureau, calling for children to be remembered in spending plans.

Babies and children’s health, wellbeing and life chances are strongly shaped by the circumstances of their birth and the environments in which they live. The pandemic has exposed widening health inequalities, with disadvantaged children falling even further behind and vulnerable children bearing the impact of disruption to education and other vital services.

“As we recover, we face a choice: do we create a more level playing field in our society? Or do we simply return to what was there before? It’s this government’s mission to unite and level up across the whole of the UK, to build back better and to build back fairer.” – Sajid Javid, Secretary of State for Health

The NCB highlights how the Spending Review is a turning point:

“Instead of going back to how things were, this is our chance to look to the future – a future where every child feels safe, secure and supported. This is our chance to Build Back Childhood to ensure that babies, children and young people are not forgotten.

Public services are caught in a cycle of increasing demand and late intervention. We risk every penny of the new NHS and social care levy being swallowed up by increased demand unless this is resolved. The Government must explicitly re-balance spending towards prevention and early intervention in childhood in order to reduce costs and burden on the NHS.

The #BuildBackChildhood campaign includes the following policy recommendations:

  • £500 million ringfenced uplifts in the Public Health Grant over the next three years to train and recruit 3000 new health visitors. This will enable local authorities to create strong and innovative health visiting services.
  • Reverse the £20 a week cut to Universal Credit and increase legacy benefits by £20 a week – reducing child poverty by 350,000.
  • Scrap the benefit cap and two-child limit – this would only cost £1.9 billion and would pull nearly 300,000 children out of poverty.
  • £103 million per year to support 500,000 young people through community mental health hubs.
  • An expansion of the Family Hubs network to provide an access point in local communities to provide help for families who need it.
  • Doubling the Supporting Families Programme to £330 million to provide early help to families facing multiple disadvantages.
  • The rapid expansion of Mental Health Support Teams so that all pupils are schools are covered by 2023.
  • Local areas to tackle the backlog of assessments and address the impact of missed therapies.
  • The launch of an independent review into childcare and early education funding and affordability, including whether current spending is sufficient to deliver the free entitlements.

“We are delighted to support this growing groundswell of organisations coming together with a united voice calling on the Government to #BuildBackChildhood . The evidence is clear, if we are serious about wanting to ‘level-up’ society and support public services which are flooded with increasing need, it is essential that we start in the earliest years of life and invest in our children, who are our future – there is no smarter investment” – Alison Morton, Executive Director iHV

NCB #BuildBackChildhood campaign supporters