DfE publishes updated “Working Together to Safeguard Children 2023”

On Friday 15 December, the Department for Education (DfE) published its updated version of “Working Together to Safeguard Children 2023”. The Department consulted with key stakeholders on proposed changes through an open consultation process between June and September this year.

To support the consultation, the Institute of Health Visiting engaged in meetings with DfE officials and submitted a written submission to the consultation in September 2023. Our considered position was developed in partnership with frontline practitioners, service leads, safeguarding representatives and our iHV Expert Advisers for Safeguarding, and through an iHV Roundtable event in August 2023 – you can read our written response to the consultation here.

“Working Together to Safeguard Children 2023” focuses on strengthening multi-agency working. It brings together new and existing guidance to emphasise that successful outcomes for children depend on strong multi-agency partnership working across the whole system of help, support and protection including effective work from all agencies with parents, carers, and families. We support this position – safeguarding is everyone’s business. There is a clear imperative to strengthen services to ensure that the most vulnerable babies, children and young people in our society are supported to achieve their full potential and are protected from harm.

This statutory guidance sets out key roles for individuals, organisations and agencies to deliver effective arrangements. It covers the legislative requirements, a framework for the three local safeguarding partners (local authorities, Integrated Care Boards and police), and a framework for child death reviews. This revision has a renewed focus on how organisations and agencies provide:

Early help
Safeguarding and promoting the welfare of children
Child protection.

Of relevance to health visiting, the guidance introduces changes to the lead practitioner role. It clarifies that a broader range of practitioner can be the lead practitioner for children and families receiving support and services under section 17 of the Children Act 1989 (Child in Need), and the requirements on local authorities and their partners to agree and set out local governance arrangements.
The guidance states:

“Once the referral has been accepted by local authority children’s social care, a social work qualified practice supervisor or manager should decide, with partners where appropriate, who the most appropriate lead practitioner will be and, with the lead practitioner’s agreement, allocate them in line with the local protocol.

The lead practitioner role can be held by a range of people, including social workers. When allocating the lead practitioner, local authorities and their partners should consider the needs of the child and their family to ensure the lead practitioner has the time required to undertake the role. The lead practitioner should have the skills, knowledge, competence, and experience to work effectively with the child and their family. The lead practitioner should always be a social worker for child protection enquiries.”

Our response to the Working Together consultation sets out our position on this. To ensure that the key preventative public health role of health visitors is not compromised, we strongly recommend that implementation and prioritisation decisions take account of the full breadth of the Health Visiting Model for England, and support delivery of the Healthy Child Programme in full. Health visitors deliver important ‘health’ functions within a whole system approach that cannot be overlooked. These support clinical pathways across the NHS (urgent, primary and secondary care) and education (child development, school readiness and Special Education Needs and Disabilities (SEND)), alongside child safeguarding. For example, supporting parents to manage minor illnesses (read our latest evidence review on the crisis in urgent care for children 0-4years), providing interventions for families affected by perinatal mental illness and a range of physical needs in the postnatal care pathway, reducing risk factors for preventable disease (addressing smoking, poor nutrition, alcohol risks and physical inactivity) and early identification and support for children with developmental delay and SEND.

We recognise that there may be occasions when having a health visitor as the lead practitioner might be in the best interest of the child and we set these out in our consultation response – in summary:

We do not support the case that health visitors should be the default lead practitioner for all babies and young children categorised as “Child in Need”.
Designation of the lead practitioner needs to be agreed on a case-by-case basis, in the best interests of the child, and only when the health visiting service is sufficiently resourced (not as a sticking plaster for an under-resourced children’s social care department). For example, when a family is being supported through a preventative public health, health visitor-led, intensive home visiting programme like the Family Nurse Partnership Programme or the Maternal Early Childhood Sustained Home-visiting (MECSH) programme, or through a targeted programme of health visiting support for a child with Special Education Needs and Disabilities (SEND).
However, care needs to be taken as there is a significant risk that, without sufficient resource, focusing health visitors’ efforts on statutory Child in Need cases will further accelerate their role drift away from preventative public health and earlier intervention (this was flagged as a national risk in our “State of Health Visiting” survey, published in 2023). Health visitors’ important “upstream” role is focused primarily on preventing, identifying and working with families to address problems before they reach crisis point. This takes pressure off children’s social care and is less costly in the long run. Health visiting is the only agency that proactively and systematically reaches out to all families with babies and young children from pregnancy and through the earliest years of life – this is a safety-critical function that needs to be protected at all costs. Without sufficient resource, eroding this “safety-net” further strips out the mechanism to identify vulnerable babies and young children.

The “Working Together to Safeguard Children 2023” guidance also includes:

New national multi-agency child protection standards which set out actions, considerations and behaviours for improved child protection practice and outcomes for children.
Clarification of roles and responsibilities of health practitioners, with specific duties for child safeguarding.
Domestic Abuse Act 2021 legislation and the National Framework statutory guidance that supports a child-centred approach.
Updated guidance and terminology on the management of child deaths and the language around the responsibility of professionals where relevant, to inform relevant safeguarding partners and the Child Safeguarding Practice Review Panel.
Guidance on Improving practice with children, young people and families which provides advice for local areas to embed working together to safeguard children and the children’s social care national framework in practice.

Funding:

The Department for Education (DfE) has announced that it is investing more than £7 million, over the next 2 years to support local areas. This consists of £6.48 million grant funding in January 2024, for safeguarding partners to:

Make changes to multi-agency safeguarding arrangements in light of the revised Working Together to Safeguard Children statutory guidance.
Build a shared understanding between agencies of what the national framework means for multi-agency working.

This funding does not cover the costs of service delivery and sustainability. The guidance sets out an expectation that “leaders are ambitious about helping, supporting, and protecting children in their area and jointly prioritise and share resources accordingly”. If fully implemented, it is clear that these changes will place additional burdens on the health visiting workforce, shifting responsibilities from children’s social care to other services.

We are concerned that, as the costs of child protection continue to soar, budgets will not be redistributed to offset the additional burdens that this guidance places on organisations taking on the lead practitioner responsibilities. Prioritisation is likely to favour statutory responsibilities. Without addressing funding and health visiting workforce issues, services will be pressurised to prioritise “Child in Need” cases at the expense of preventative public health, leaving more families without the support that they need in other areas and proving much more costly in the long run.

This guidance presents an important opportunity to improve the care, support and safety of babies, children and young people. Its success will depend on its implementation as part of a whole system approach that also includes prevention and early intervention. As this directive represents a new national policy, we strongly recommend that its implementation is subject to the scrutiny of the Office for Budget Responsibility to ensure that it is fully costed and any additional burdens placed on services are managed with a commensurate budget uplift, workforce planning and action to address the current postcode lottery of health visiting service provision.

Next steps:

NHS Safeguarding is developing a safeguarding workplan to support the implementation of this guidance (we understand that the draft plan is due in mid-January 2024). At the iHV, we will be working closely with officials in the Office for Health Improvement and Disparities, NHS Safeguarding, and partners in other professional bodies and organisations including the School and Public Health Nurses Association, Association of Directors of Public Health and Local Government Association, to consider the specific implications of the Working Together 2023 guidance for health visiting and to support its implementation in practice.

The full suite of Working Together 2023 documents is available here:

Read iHV written response to the DfE - Working Together to Safeguard Children: changes to statutory guidance consultation

iHV publishes submission to Working Together to Safeguard Children consultation

Earlier this month, the iHV submitted a written response to the Department for Education’s Working Together to Safeguard Children: changes to statutory guidance consultation.

Working Together to Safeguard Children is the multi-agency statutory guidance that sets out expectations for the system that provides help, support and protection for children and their families. It applies at every level from senior leaders to those in direct practice with families, and across all agencies and organisations that come into contact with children. It gives practitioners clarity about what is required of them individually and how they need to work in partnership with each other to deliver effective services.

Updating ‘Working Together’ forms a central part of the Government’s plans to transform Children’s Social Care, set out in Stable Homes, Built on Love. The plans aim to strengthen multi-agency working across the whole system of help, support and protection for children and their families, with greater emphasis on earlier help and strong, effective and consistent child protection practice.

The Working Together consultation ran from 21 June 2023 to 6 September 2023 and views were sought from children and young people, parents and carers, and others who are ‘essential to children’s safety and welfare’. Officials at the Department for Education contacted the iHV with a direct request for a response to the proposal that health visitors might become lead professionals for children subject to Child in Need – section 17 arrangements. Our submission is therefore focused on the questions that relate to this proposal.

Our response was formulated with support from members of the iHV Working Together Safeguarding Roundtable Event that was held on 21 August 2023. The group met specifically to consider the impact of the proposed changes to the statutory guidance on health visiting practice. Further practitioner intelligence, and views on the proposed changes, were also collated from direct emails that the iHV received from members and discussions with partners during the consultation period.

Read our response here

What happens next?

The results of the consultation and the department’s response will be published on GOV.UK in Autumn 2023.

With special thanks to Trish Stewart, iHV Expert Advisor for Safeguarding and Associate Director for Safeguarding and Children’s Public Health Nursing at Central London Community Healthcare NHS Trust; Georgina Mayes, iHV Policy and Quality Lead; and members of the iHV roundtable event for their valuable input and support with this submission.

iHV submits response to Children’s social care strategy and consultation

The Institute of Health Visiting submitted its response to the Children’s social care strategy: Stable Homes, Built on Love on 10 May 2023. The Department for Education (DfE) has been seeking views on their proposals to reform children’s social care. The vision for reform of children’s social care responds to recommendations made by three[1] independent reviews. The vision is underpinned by the fundamental principle of the Children Act 1989 – that children’s welfare is paramount.

The vision aims to rebalance children’s social care away from costly crisis intervention to more meaningful and effective help for families, so that it achieves the outcomes that children deserve. Achieving this will require a major reset that puts love and stable relationships at the heart of what children’s social care does.

DfE has promised to take action across six pillars to transform children’s social care:

Pillar one: Family Help provides the right support at the right time so that children can thrive with their families
Pillar two: A decisive multi-agency child protection system
Pillar three: Unlocking the potential of family networks
Pillar four: Putting love, relationships and a stable home at the heart of being a child in care
Pillar 5: A valued, supported and highly-skilled social worker for every child who needs one
Pillar 6: A system that continuously learns and improves, and makes better use of evidence and data

The consultation focuses on their proposed response to various recommendations including:

Support and protection for children and families
Support for kinship carers, and wider family networks
Reforms to the experience of being in care, including corporate parenting
Support for the workforce
Delivery and system reform

In our response, we recognised that this consultation provides an ideal opportunity for much greater collaboration and a joined-up cross-departmental approach to child safeguarding and early help between the Department for Education and the Department of Health and Social Care. Whilst there is reference to the importance of ‘close integration with the wider support system’ in the proposals, more weight needs to be given to the ‘upstream’ functions of prevention, early identification of need, and early intervention below the threshold for children’s social care. These represent a significant gap throughout the whole vision. We urged the review team to take advantage of this opportunity to develop a whole system response for babies, children and families from the heart of government to frontline practice, including a dedicated budget for prevention and early intervention to support more seamless and integrated support for families and at the scale needed to respond to growing levels of need.

You can read the iHV’s response to the Children’s social care strategy and Consultation: Stable Homes, Built on Love here.

The iHV would like to say a huge heartfelt thank you to our iHV Safeguarding Expert Advisers for their expert advice and guidance when writing this evidence submission:

Dr Michael Fanner – Strategic Advisor – Global Safeguarding, Specialist Research, Education and Training and Safeguarding in Health
Trish Stewart – Associate Director of Safeguarding for Central London Community Healthcare NHS Trust

Read iHV’s response to the Children's social care strategy and Consultation: Stable Homes, Built on Love

[1] The three reviews are: The Competition and Markets Authority’s Children’s Social Care market study 2022; Child Protection in England 2022; and the Independent Review of Children’s Social Care 2022.

iHV submits response to Hewitt Review consultation

iHV submits response to the Hewitt Review consultation on Integrated Care Systems

Just before Christmas, the Government launched their consultation on the oversight and governance of Integrated Care Systems (ICSs) in England. The Secretary of State for Health and Social Care appointed the Rt Hon Patricia Hewitt to lead this review with a call for evidence to gather views from across the health and social care system, as well as from patients, the public, and the wider voluntary sector – the call for submissions closed today, 9 January.

ICSs were placed on a statutory footing on 1 July 2022, with the creation of:

integrated care boards (ICBs), which are statutory NHS bodies
integrated care partnerships (ICPs), which are joint committees formed by each ICB and the relevant local authorities in the ICS area.

ICSs bring together the NHS, local government, the voluntary, community and social enterprise (VCSE) sector, and other partners, with the aim to better integrate services and take a more collaborative approach to agreeing and delivering ambitions for the health and wellbeing of their local population.

The purpose of ICSs is to bring these partner organisations together to:

improve outcomes in population health and healthcare
tackle inequalities in outcomes, experience and access
enhance productivity and value for money
support broader social and economic development.

The iHV has submitted written evidence to this review which sets out the vital role that health visitors play in achieving these ambitions – as an infrastructure of support, and the ‘backbone of the early years… the safety-net around all families’ (WHO UNICEF UK, 2022).

Health visitors are highly skilled Specialist Community Public Health Nurses, ideally placed to act as local leaders in ICSs, working collaboratively with others to facilitate a place-based response to improve health and reduce inequalities. All families have a health visitor, and their frontline practitioner intelligence provides an important ‘early warning signal’ of the most pressing threats to the health of our youngest citizens who are often hidden behind front doors and invisible to other services.

However, our submission also highlights that ICSs are being developed in deeply challenging times for babies, children and their families, with increased levels of need and widening inequalities, alongside political and economic instability, and varied levels of healthcare performance. Health visiting faces a significant workforce shortage, with almost 40% fewer health visitors compared to 2015, and problems with recruitment, retention and career progression. Consequently, many families are not receiving the support that they need, and this is being intensified by a lack of capacity in other health and social care services who are also experiencing extreme pressures – with increased risk and detrimental impacts on child health and development.

We want ICSs to succeed. It is not too late to change direction and pursue reforms, but the situation is serious. The current rate of health visitor workforce attrition, with no national workforce plan to plug the forecasted gaps, is not sustainable and will jeopardise the delivery of England’s child health programme. The government categorised health visiting as one of six priority services in its Start for Life Vision for the first 1001 days. However, this commitment is at risk without investment and a plan to rebuild the health visitor workforce. There is also a significant risk that the current context makes it harder for the original vision of much better-integrated care across the system to be fulfilled.

More information about the objectives and scope of the review can be found in the Hewitt review terms of reference.

Read iHV's submission to the Hewitt Review

iHV Submission to the Down Syndrome Act Guidance: call for evidence

iHV has submitted its evidence for the DHSC Down Syndrome Act 2022 guidance: call for evidence which closes at 11.45pm on 8 November 2022.

The evidence base of what families with babies and children with Down’s syndrome value from health and related services has increased in recent years and should be acted upon in the design of services including health visiting. People with Down’s syndrome have a genetic variation. Whilst they share some common features, it must be emphasised they are all individuals with their own abilities, needs, interests and aspirations. Down’s syndrome is not a disease and people who have Down’s syndrome are not ill.

In the document below, we provide evidence in response to the questions for professionals, about health services, and in relation to the health visiting service in England.

iHV evidence for Down's Syndrome consultation submission - October 2022

iHV has resources to support its members in practice – please see Good Practice Points below:

GPP – Supporting children with Down’s syndrome and their families

GPP – Supporting children with Down’s syndrome: growth, feeding and development

iHV submits response to SEND review consultation

iHV submits response to the Government’s special educational needs and disabilities (SEND) review consultation

Yesterday, we submitted the Institute of Health Visiting’s response to the Government’s SEND Green Paper consultation. Our response was led by Georgina Mayes, our Policy and Quality Lead, in collaboration with a range of stakeholders from across the sector and based on the best evidence of what works. We support the ambitions of the Green Paper’s policy proposals to end the postcode lottery of SEND provision, and our response aims to ensure that the needs of babies, young children with SEND and their families are recognised as early as possible and effectively addressed.

The review sets out the Government’s proposals for a system that offers children and young people the opportunity to thrive, with access to the right support, in the right place, and at the right time, so they can fulfil their potential and lead happy, healthy, and productive adult lives.

Alison Morton, iHV Executive Director, says:

“Nobody can argue with the aspirations set out above – what we now need is sufficient resource and the action that will be needed to make the difference for babies and children with SEND, and their families. There is no dress rehearsal for the earliest years of life which lay an important foundation for lifelong health and wellbeing – what happens during this time matters for all children, and it really matters for children with SEND who are currently being let down.

“If we are serious about improving outcomes for children with SEND, we need investment to reverse years of cuts to prevention and early intervention services. This includes rebuilding the health visiting workforce. Cutting this universal safety-net of skilled professionals, that reach all families to identify the early signs of SEND, has been a false economy as any short-term savings are quickly offset by increased delayed treatment costs and, for some, the consequences have been catastrophic”.

In our response to the consultation, we have sought to provide constructive feedback on the proposals and to suggest areas that we think the Department for Education and the Department of Health and Social Care should explore further. We have not responded to all the questions in this comprehensive consultation – we have specifically responded to the consultation questions that are relevant to the health of babies, young children, and their families.

We remain committed to ensuring that babies are not overlooked in national policy – we were therefore disappointed to see the lack of focus within the Green Paper on prevention and the early identification and support for babies and young children with SEND. Early intervention relies on the early identification of babies and young children at risk of poor outcomes – without an acceptable universal mechanism of identifying these children who are often invisible to services, all strategies will struggle to reach underrepresented groups and reduce inequalities.

Babies and young children are citizens in their own right and they are entitled to the same access to health and social care as older children and young people, but they rely on the adults around them to be their voice when their parents or carers are unable to speak for them. It is vital that their voice is heard in this consultation.

We recommend that the scope of the forthcoming policy is ambitious and extends beyond the Department for Education, with clear commitments and lines of accountability that extend across the multiple government departments that contribute to SEND outcomes. In particular, our response has focused on the vital contribution that health visitors bring to the success of the SEND programme. The need to improve the coordination of care for these families is well documented – health visitors are a skilled workforce who can support parents to navigate the complex systems of support.

It is widely recognised that parents of children with complex health needs are at increased risk of experiencing additional stress; parenting a disabled child goes beyond ‘ordinary’ parenting. It is not surprising, therefore, that parents of children with SEND are more likely to require support than parents of non-disabled children. Services which are accessible and offer a partnership approach where parents are involved in decision making result in improved parent satisfaction, decreased parental stress, and an improvement in child outcomes.

Services need to be flexible and promote individualised care which requires that joint working is coordinated between the family and all practitioners involved. Health visitors also play a crucial role in supporting access to wider support (such as improving uptake of Early Years provision, relevant disability and income-related benefits, and reducing parental conflict), as well as effective transition to school and the school nursing service.

Fundamentally, the success of any SEND plan hinges on having the right workforce with the right skills and in sufficient numbers to address the level of need. Current workforce challenges are significantly hampering improvements in the quality and amount of care and support that families receive and cannot be ignored. We have specifically highlighted how cuts to health visiting services have had a direct impact on the timely referrals to specialist services with many services reporting problems with late identification of SEND and wider vulnerabilities.

Georgina Mayes, iHV Policy and Quality Lead says:

“Unless workforce shortages are addressed, then no amount of planning, strategy, partnership working or understanding of need is going to work. A well-resourced national health visiting workforce plan is needed as part of a whole system’s approach to improving the lives of babies, children, and young people with SEND. We need more health visitors!”

We would like to thank the health visitors, parents and charity organisations who have contributed to our response to this consultation. We really value their time, commitment, expertise and knowledge.

We look forward to seeing the publication of the Government’s SEND Green Paper consultation. For more information, read the iHV’s consultation response (PDF).

If you would like to stay updated on and get involved in this work, please contact [email protected]

Read iHV's response to the Government's SEND Green Paper consultation

Consultation – SEND review: right support, right place, right time

The Government is seeking views on their green paper about the changes they want to make to the special educational needs and disabilities (SEND) and alternative provision (AP) system in England.

The Government commissioned the SEND Review in September 2019 as a response to the widespread recognition that the system was failing to deliver improved outcomes for children and young people and that parental and provider confidence was in decline. The SEND review green paper sets out the Government’s proposals for a system that offers children and young people the opportunity to thrive, with access to the right support, in the right place, and at the right time, so they can fulfil their potential and lead happy, healthy and productive adult lives.

The SEND Review highlights key areas for the case for change:

Children and Young People with SEND and those in alternative provision have consistently poorer outcomes than their peers
Experiences of the SEND and AP provision system are negative
The SEND and AP system is financially unsustainable
There is too much inconsistency across the SEND system in how and where needs are assessed and met
A vicious circle is driving these challenges

The Government has opened a consultation to improve outcomes for children and young people in England with SEND and those in alternative provision.

To achieve this ambition, the Government wants to work with and hear from:

children and young people
parents and carers
those who advocate and work with the SEND sector
local and national system leaders

We have 13 weeks to get this right, so please consider the proposals set out in the Government’s green paper and respond to their consultation.

Together, we can ensure that every child and young person with SEND and those in alternative provision can thrive and be well prepared for adult life.

iHV is collating a response to this consultation – please contact us (via email to [email protected] by 10 June 2022) if you have comments that you would like us to consider as part of our submission.

Go to Government Consultation information

This consultation closes at 11:45pm on 1 July 2022.
If you have comments that you would like iHV to consider as part of our submission, please send via email to [email protected] by 10 June 2022

A separate summary covering the SEND and AP green paper and responding to the consultation is also available.

A British Sign Language (BSL) version and an easy-read version of the green paper will be available in early April.

If you would like a Braille or audio version of the green paper or an accessible format that is not listed, email [email protected].

iHV publishes response to NMC consultation

iHV publishes its response to the Nursing and Midwifery Council (NMC) online consultation on Draft standards for post-registration nursing including Specialist Community Public Health Nursing – health visiting.

We welcome the development of proficiencies specific to the three SCPHN fields of health visiting, school nursing and occupational health nursing. We believe that this is an important strengthening of the regulatory status of health visiting so that the public can have assurances of what can be expected of a SCPHN health visitor. We also set out some additional recommendations for enhancements of the draft proficiencies themselves.

We believe that the proposed new standards provide a timely opportunity to re-envision health visiting and Specialist Community Public Health Nursing. We are committed to build on the strength of evidence in support of the vital contribution SCPHN health visitors make to improving the health and life chances of people across the life-course from its earliest days in their families, communities where they live, learn and work at a time of widening inequalities and persistent as well as new public health challenges.

Read our response to NMC consultation

We strongly encourage all health visitors and others with an interest in child and family public health to take the opportunity to make their own responses to the NMC consultation and we hope that, by publishing our response, this will assist health visitors and others to consider their own responses to the consultation. The closing date for responses to the consultation is 2 August 2021.

Please also see our Voices Blog on ‘Future Health Visiting’ – summarising the key issues.

Collective system failure puts vulnerable children at risk

Originally published 1 July 2021

Joint letters from the Institute of Health Visiting (iHV) and the School and Public Health Nurses Association (SAPHNA) warn national and local leaders that the proposed cuts to health visiting and school nursing services in Hampshire will put children at risk of harm.

Despite rising levels of safeguarding concerns nationally which saw 285 children killed or seriously harmed in the first 6 months of lockdown in England, Hampshire County Council has forged ahead with their plans to cut their health visiting and school nursing services intended to support families and safeguard children.

Concerns have been raised that the proposals described as “Serving Hampshire, balancing the budget” bear no resemblance to the national Healthy Child Programme which sets out a programme of support for all babies, children, and their families. Within the proposed plans to reduce the 0-19 Public Health Nursing Service budget by £2.09 million per year are significant elements that will undermine delivery of the Healthy Child Programme, drastically cut the support available to families, and strip out the mechanism to identify vulnerable children:

cutting approximately 47 staff posts (12.5% of the current workforce);
for children 0-5 years, all children will only receive one mandated face-to-face health review. All other reviews will be “risk assessed to decide whether they should be completed face-to-face, by video or by telephone”;
only providing school nurse support to children and young people over the age of 11 years through the ‘digital offer’, i.e. NO face-to-face service;
minimal school nursing statutory involvement in safeguarding and child protection.

The whole health and social care system is interconnected and changes like these cannot be made in isolation without consideration of the wider system impact; making radical cuts like these will cause harm to children and will create a ripple effect across other services like GPs, secondary care, and children’s social care that are already stretched and need to be accounted for.

The iHV and SAPHNA believe there are several sets of grounds which, singly and severally, mean the County Council and national government ought to review these plans, to ensure that they are not in breach of their statutory safeguarding responsibilities nor undermine the delivery of the Healthy Child Programme which has been mandated by government.

Post-covid, it is even more important that families with babies and children are supported, with rising levels of children living with vulnerability and risk. England already has a significant problem, with 1/3 of all vulnerable children recognised as ‘invisible’ [1] within the system and therefore not receiving the support that they need. Our children are also the unhappiest across Europe. This proposed model would place them at even greater risk

These cuts are the predicted consequences of insufficient funding and inadequate system levers, alongside a lack of prioritisation of prevention and early intervention at all levels. An urgent national review is needed to acknowledge the root cause of these cuts, and their significant wider system impacts, with a clear plan to tackle them once and for all.

Sharon White, CEO SAPHNA, said:

“We have seen a number of recent and significant cuts to health visiting and school nursing services with more planned; this must stop. We are fully versed in the Governments budget cuts, reduced public health grant and cash-strapped councils with our services clearly seen as ‘easy pickings’ in trying to rectify; this false economy as only serves to kick the can down the road, resulting in increased costs to services to say nothing of the long-term impacts on children’s and families’ lives.

We have more than enough evidence to demonstrate that our public health practice can and does make a vital difference. Hampshire’s proposals are radical, dangerous and a disservice to its population. We cannot and must not accept this.”

Alison Morton, Executive Director at the Institute of Health Visiting, said:

“We should all be worried about what’s happening in Hampshire. The proposed changes in Hampshire represent an important national test case, rather than an isolated outlier that only needs to be addressed locally. The national Government’s response is that it’s down to local authorities to decide how they manage their budgets. Conversely, the local authorities’ perspective is that the cuts are due to a lack of government funding. Both are true – and the time has come to move beyond this stalemate and find a sustainable solution that puts babies, children, and their families first. Unless resolved, families ultimately bear the brunt of these cuts.”

The council is seeking residents’ and stakeholders’ views on their proposals through an open consultation process. We urge as many people as possible to “have your say” by responding to this consultation. The consultation Information Pack provides further detail about Public Health services in Hampshire, the four areas under consideration and the options for change – available here.

The iHV response: Since the consultation was launched, the iHV has been working constructively and in collaboration with the School and Public Health Nurses Association, the unions, and colleagues in Hampshire County Council to find a resolution that meets the needs of babies, children, and their families. At the end of last week, the iHV and SAPHNA sent a joint letter to both Hampshire County Council and Public Health England outlining their concerns.

Serious Incident Notifications: The total number of serious incident notifications for children during the first half of 2020-21 increased by 27% (n=285) on the same period in 2019-20 – of these, 35.8% relate to under 1s who remain at the highest risk of homicide than any other age group[2].

[1] https://www.childrenscommissioner.gov.uk/report/childhood-vulnerability-in-england-2019/

2 BETA: .GOV.UK (2021) Part 1 (April to September) 2020-21. Serious incident notifications https://explore-education-statistics.service.gov.uk/find-statistics/serious-incident-notifications

Future health visitors – shaping the proposed NMC SCPHN Standards

Last week the NMC launched its consultation on draft standards for community and specialist community public health nursing (SCPHN). These set the expectations of future health visitors along with school nurses and occupational health nursing. The new NMC standards offer the opportunity to build on the advances in the evidence base for universal child and family health visiting for the pressing public health challenges of our times. It is vitally important that the views of health visitors are heard and shape these new standards.

The NMC is providing opportunities to be informed of the issues, to ask questions and to take part in the consultation. We encourage all health visitors to take up these opportunities.

iHV members can also shape the iHV’s response by joining us at our forthcoming iHV networking events for members which will focus on the NMC consultation:

iHV Student Networking Event – Future health visiting: Next steps for me and the profession

21 May 2021 (for student health visitor iHV members only)

In our first “iHV Student Networking Event” on 21 May, we will explore the crucial first year and preceptorship; and we will share views on the draft NMC standards for the Future SCPHN-health visiting.

Your experiences matter and will help us to formulate our response to the NMC’s consultation on the proposed standards. We have invited a short input from the NMC as well as from a practitioner with recent experience of preceptorship.

This webinar is for iHV Student Members ONLY. To book on, you will need your iHV membership number to access the tickets.

Book your place here today for our iHV Student Networking Event - don't forget you need your iHV membership number

Practice Education Networking Event – Future health visiting: Next steps for the profession

16 June 2021 (open to all iHV members)

In our second “Practice Education Networking Event” on 16 June, we extend a wide invitation to all our iHV members who have an interest in education and standards for future health visitors. This too will help us to formulate our response to the NMC’s consultation on the proposed standards and we have invited a short input from the NMC as well as from a current Lead Practice Teacher / Assessor – health visitor.

This webinar is for iHV Members ONLY. To book on, you will need your iHV membership number to access the tickets.

Book your place here today for our Practice Education Networking Event - don't forget you need your iHV membership number

Where can I find more information on the consultation?

We encourage all health visitors (whether you are an iHV member or not) to take the time to read the NMC consultation documents.

The new standards are intended to equip future health visitors to meet the public health needs of the future.

The four principles of health visiting formulated in 1977, and later included in current standards of proficiency for SCPHN have stood the test of time. Now is the time to consider whether the draft standards:

Provide a compelling vision for the future of health visiting across the four nations of the UK;
Proposed six ‘spheres of influence’ are pitched at the right level and are relevant to emerging health needs and the evidence base for practice;
‘Field-specific’ proficiencies for health visiting capture the distinctive knowledge, skills and attributes required for future health visitors;
Will command the support of the profession; and
Will help service users and employers to know what can be expected of the SCPHN health visitor.