Spotlighting the vital “safety net” that health visitors have provided for babies and young children during the current pandemic

The Institute of Health Visiting (iHV) has published “Making History: health visiting during COVID-19”, a collection of case studies which presents a window into the working lives of health visitors and families navigating the ups and downs of the COVID-19 pandemic.

In these unprecedented times, the world “locked down”. Yet life continued, babies kept being born and the normal struggles of parenthood became amplified for many.

Whilst some families enjoyed the relative peace of an enforced slower pace of life; most families were negatively impacted by lockdown and home was not a safe place for some, with rates of domestic violence and abuse, mental health problems and safeguarding concerns quickly becoming a source of concern.

The case studies, family stories and creative pieces contained within “Making History: Health visiting during COVID-19” capture the pace and scale of change as health visiting services adapted to working during “lockdown”.

Alison Morton, Director of Policy at the Institute of Health Visiting, commented:

“It has taken a global public health pandemic to shine a spotlight on the importance of the health visiting service.

“Parents reached out to health visitors for support as many other sources of support were no longer available. Health visitors are Specialist Community Public Health Nurses providing a vital “safety net” for babies, young children and their families whose needs can easily be hidden from sight. Their specialist public health skills, supporting babies, young children and their families during the biggest public health emergency in living memory, have been needed more than ever.”

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” instead of face-to-face, as well as rapidly responding to urgent needs to support families using Personal Protective Equipment.

Councillor Ian Hudspeth, Chairman of the Local Government Association Community Wellbeing Board, commented:

“Councils are incredibly proud of how their public health workforce has responded over the last 6 months. This report is testimony to the commitment and resilience of health visitors and illustrates the pivotal role they play in ensuring children and families get the support they need in challenging times.

“In the upcoming Spending Review, we are asking the Government to reverse the £700 million of public health reductions, to enable councils to strengthen this workforce and ensure we can continue to support families when they need us most.”

Alison Morton concluded:

“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.”

Read iHV's Making History: health visiting during COVID-19

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

Disappointment at Government Response to Petitions Committee report

The Government has given their response to the Petitions Committee’s landmark report on the impact of COVID-19 on maternity and parental leave.

The report was the result of an extensive inquiry following an e-petition calling for the Government to extend maternity leave by 3 months with pay in light of COVID-19 which received over 226,000 signatures, and to which Dr Cheryll Adams contributed some evidence via Zoom in May earlier this year (see iHV at Petition Select Committee).

Dr Cheryll Adams commented on today’s news on the Government Response:

“The Government Response to the report by the Petitions Committee’s recommendations on the impact of COVID-19 on parental leave is a disappointing response by government to such powerful lobbying by parents. So many new families have struggled during the past 6 months and more acknowledgement of that, in the form of positive responses to at least some of the recommendations, would have meant that they felt more valued in their essential role of bringing up the next generation.”

Read Petition Committee express disappointment at Government response to its report on impact of Covid-19 on maternity and parental leave

Read The impact of COVID-19 on maternity and parental leave: Government Response to the Committee’s First Report

A Public Health Nursing Infant Feeding Service during COVID-19 – World Breastfeeding Week 2020

This week is World Breastfeeding Week 2020, running from 1-7 August. The week aims to raise awareness of the links between good nutrition, food security, poverty reduction and breastfeeding, and galvanise action to increase breastfeeding rates.

2020 has brought new challenges as infant feeding support services have needed to quickly adapt to the restrictions of COVID-19 lockdown and physical distancing. However, these conditions have also provided the opportunity for services to innovate and work together to ensure that women and babies receive the support that they need to successfully breastfeed.

We are delighted to be able to showcase the innovative work of the health visiting infant feeding service in Devon led by Gail Barker, Infant Feeding Coordinator Devon Public Health Nursing. This peer-reviewed case study has been selected for inclusion as part of our “Making History: Health Visiting during COVID-19” collection of case studies due to be published later this month.

Gail’s case study presents 12 learning points that contain a wealth of transferable tips gathered by the health visiting service in Devon during the first 12 weeks of the implementation of their adapted support service. Their experiences will resonate with others facing similar challenges which Gail outlines, “Staff were scared, families vulnerable. We needed to continue to keep everyone, families and staff alike safe, informed and supported with infant feeding challenges. We needed to be able to assess latch, build peer relationships, support growth and development, promote, protect and support breastfeeding, all whilst working in an integrated manner with our partners and parents”.

Commenting on the importance of supporting breastfeeding during these challenging times, Gail Barker said:

“Improving the UK’s breastfeeding rates is acknowledged as a key factor in improving the health of a population. Through being able to continue to support infant feeding via video teleconferencing at such a challenging time, we were able to support and promote the health of each baby and mother supported by our service. We know that infant feeding supports not only the building of close and loving relationships, which in turn promotes mental health of both mother and baby (Unicef, 2019), but it also has significant health impacts and reduces health inequalities (Victora et al 2016). At this time of COVID-19, it has never been more important to focus on children in view of these considerations for now and for the future, not just in the UK, but globally”.

Read Gail Barker's case study

Please see further resources and blogs to support breastfeeding during COVID-19:

Download iHV Parent Tips: Supporting breastfeeding during COVID-19

Read Dr Alison Spiro’s Voices blog published during England’s breastfeeding awareness week in June 2020 – Breastfeeding during the COVID-19 crisis

Accelerating the return to near-normal levels of non-Covid health services

On 31 July, plans for the next – third – phase of the NHS response to the COVID-19 pandemic, effective from 1 August 2020, were set out in a letter from the Chief Executive Sir Simon Stevens & Chief Operating Officer Amanda Pritchard; this includes providers of community services.

The Government has agreed that the NHS Emergency Preparedness, Resilience and Response (EPRR) incident level will move from Level 4 (national) to Level 3 (regional) with effect from 1 August. This approach matches the differential regional measures the Government is deploying and builds on the guidance set out in the COVID-19 restoration of community health services for children and young people: second phase of NHS response to “fully restore [the health visiting] service, with some prioritisation where indicated and as capacity dictates”.

The priorities for this phase are:

Accelerating the return to near-normal levels of non-Covid health services, making full use of the capacity available in the ‘window of opportunity’ between now and winter
Preparation for winter demand pressures, alongside continuing vigilance in the light of further probable Covid spikes locally and possibly nationally.
Doing the above in a way that takes account of lessons learned during the first Covid peak; locks in beneficial changes; and explicitly tackles fundamental challenges including: support for our staff, and action on inequalities and prevention.

Read the letter here

iHV welcomes Babies in Lockdown report

Charity collective, Best Beginnings, Home-Start UK and the Parent-Infant Foundation, publish a new report sharing families’ experiences of lockdown during pregnancy or with a baby.

Babies in Lockdown: listening to parents to build back better (2020), based on a survey of over 5000 families, highlights the chronic under resourcing of services for families, the inequalities in babies’ early experiences and its worsening forecast due to the COVID-19 pandemic. The report warns that many families with lower incomes, young parents and those from Black, Asian and minority ethnic communities, will have been hit hardest by the pandemic. The Babies in Lockdown Report shines a light on UK baby inequalities as charities call on Government to act now to avoid a “Post-COVID19 lottery”.

Dr Cheryll Adams CBE, Executive Director iHV, commented:

“The iHV welcomes this excellent report which lays bare just how challenging it has been for many parents during lockdown. It was distressing to read their stories and, in particular, how the most disadvantaged have felt the hardest impact of lockdown and lack of support. It is important that we listen to the voice of these parents and ensure that we are better prepared to meet the needs of young children and their families as the pandemic continues. We support the report title, we now need to build back better for infants and their families and this will include ensuring that all families receive support from the health visiting service during this crucial stage of their parenting journey”.

The report tells us that:

COVID-19 has affected parents, babies and the services that support them in diverse ways.
Families already at risk of poor outcomes have suffered the most.
Without action, the pandemic could cast a long shadow on the lives of some babies.

The Babies in Lockdown: listening to parents to build back better (2020) report makes three policy calls for the UK Government:

A one-off Baby Boost to enable local services to support families who have had a baby during or close to lockdown.
A new Parent-Infant Premium providing new funding for local commissioners, targeted at improving outcomes for the most vulnerable children.
Significant and sustained investment in core funding to support families from conception to age two and beyond, including in statutory services, charities and community groups.

Read Babies in Lockdown: listening to parents to build back better (2020) full report

Read Babies in Lockdown Executive Summary

Go to Babies in Lockdown website for more info

iHV comments on UCL survey on impacts of COVID-19 on Health Visiting in England

According to a new survey from University College London (UCL), health visitors are concerned that the needs of children have been missed due to staff redeployment to support the COVID-19 workforce and increased caseloads.

Download The impacts of COVID-19 on Health Visiting in England - first results

The UCL survey of 663 health visitors in England, conducted between 19 June and 21 July 2020, found that 41% of respondents in teams that lost staff had between 6 and 50 team members redeployed between 19 March to 3 June 2020.

In approximately 10% of teams, which experienced a loss, this was a redeployment of at least half of their staff. Few teams (9% among those with staff redeployed) gained additional staff to fill the gaps. This meant that 253 respondents (38%) had their caseload increase, some with an increase of 50% or more, and 73% of those that experienced a change reported that their caseload had not returned to its usual size.

Dr Cheryll Adams CBE, Executive Director iHV, commented:

“The interim results of this research into the impact of redeployment of health visitors by University College London confirms all the anecdotal evidence already sent to the iHV by health visitors. Health visitors should never have been redeployed, instead their time should have been spent on reaching the most vulnerable families during lockdown and checking in on all other families. I don’t believe we yet fully know the impact of that period on children and families, but this research confirms that it was very significant for many families. Furthermore, there were significant impacts on the health visitors themselves, as those remaining strived to provide redesigned services and to reach the most vulnerable families, and those redeployed worried about the families they had left behind without opportunity for necessary handovers. I find the feedback on how the health of health visitors was impacted particularly distressing, this should not have been allowed to happen.

“Developmental reviews have now been delayed for more than four months and that too will mean that developmental delays are being missed and this could impact children for the rest of their lives. The already very diminished health visiting service in some areas of the country will be struggling to catch up whilst also juggling the challenge of maintaining their personal safety, and that of families. If we do face a second wave of COVID-19, health visitors must not be redeployed again. Instead, an urgent workforce plan is needed to rebuild numbers in the profession which are at their lowest for very many years and, alongside that, tackle the huge inequities in service delivery across England which have opened up over the past five years. It is not right that whilst children in some areas of the country continue to receive a reasonable service, children in many other areas now only receive a skeleton service, made even worse now by the challenges of service delivery during the COVID-19 pandemic.

“The first years of life lay down the foundations for our future health and wellbeing – get it right then and children will thrive and achieve at school and in the workplace; get it wrong, as we are now in England, and governments for many years to come will be paying for the consequences. The critical value of health visiting services is understood and invested in by the Scottish, Welsh and Northern Ireland governments. However, in England, it is not OK that an unwarranted variation of service quality has been allowed to open up as health visiting numbers continue to be allowed to plummet. I hope that the interim findings of this research will lead to prompt action. They have been published early as the researchers were so concerned by what they found.”

Dr Gabriella Conti, Associate Professor (UCL Economics and Institute of Fiscal Studies) who led the survey, said:

“Whilst all families are impacted by COVID-19, the most detrimental effects are felt by those who are already disadvantaged – in particular, our most vulnerable infants and children whose needs are often hidden from sight.

“Increased caseloads for a significant proportion of health visitors, along with reports of a lack of PPE for home visits, has created a lot of additional stress and anxiety, during a time of great uncertainty and difficulty.”

The researchers make a number of policy recommendations, including for:

Health visiting services to be reinstated (where not already happening) to provide vital support and a safety-net for children, with appropriate measures put in place, including the use of PPE, to reduce the spread of the virus.
An evaluation of the use of virtual, non face-to-face service delivery methods 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 clear workforce plan to ensure that the health visiting service has sufficient capacity to manage the backlog of missed appointments, as well as demand for support due to the secondary impacts of the pandemic.
A proactive plan to ensure staff wellbeing during the restoration of services.

Research assistant Abigail Dow (UCL Economics) said:

“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 survey, supported by the Institute of Health Visiting, was carried out using the online survey platform Qualtrics. Participants (98% female, 88% White British or Irish, and average age 50) were obtained with consent from the Institute of Health Visiting database. Data collection is still ongoing and a full report will be released later this year.

PHE statement: face coverings for babies and very young children

Public Health England statement on PHE warning: face coverings for babies and very young children

Professor Viv Bennett, Chief Nurse at Public Health England (PHE) said:

“PHE has been made aware that face coverings for babies and very young children are available for sale in England. Guidance is clear that children under the age of three years should not wear face coverings or masks, these masks should not be used as they are potentially dangerous and can cause choking and suffocation.

If you or your child is unwell with the symptoms of COVID-19, then you should get a test and stay at home until you get the result. If you are worried then you should call 111 or speak to your doctor.”

Background:

Children aged under three years of age should not wear face coverings or masks
Wearing face coverings/masks is not compulsory in any public setting for children aged 3-11
We advise adults and children over the age of 11 years to wear face masks in enclosed public spaces where it is difficult to socially distance. This may help prevent transmission of virus to someone else if you are infected but do not yet have symptoms
Any adult or child with symptoms should self-isolate in line with the stay at home guidance and get tested.

Who is providing a safety net for babies and young children?

With many health visitors in England redeployed during the early weeks of the pandemic, Alison Morton’s paper published in the July issue of Journal of Health Visiting considers the consequences for children and families, as well as the health visitors intended to support them – Who is providing a safety net for babies and young children?

A recent survey highlighted that health visitors experienced the highest level of redeployment during the COVID-19 pandemic in comparison with social workers and midwives (Barlow et al, 2020). This happened at a time when families’ needs and vulnerabilities were increasing due to the secondary impact of lockdown, and when many support services were scaled back.

But was the redeployment of health visitors necessary? Are there lessons we need to learn from the delivery of the national emergency plan to ensure that we are better prepared in the future?

Redeploying specialist community public health nurses into non-public health roles during the biggest global public health emergency we have experienced in living memory would appear to be counter-intuitive. However, to understand the decisions made, it is important to avoid ‘hindsight bias’ – a common pitfall that occurs when we view circumstances based on the information we have after the event that was not available to the people involved at the time.

“If we face a second wave of infections, will future emergency plans include the redeployment of health visitors? We hope that this will not be the case, and that lessons will have been learned. It is vital that the needs of children and families are prioritised and given the attention they deserve..”

Go to Journal of Health Visiting: Who is providing a safety net for babies and young children?

Many thanks to Journal of Health Visiting for providing free access to this paper.

Bookings now open for next iHV Insights

Our 3rd iHV Insights webinar takes place on Thursday 16 July 3.30 to 4.30 pm.

This will cover the topic of: “Health visiting during a pandemic and beyond”.

The session will focus particularly on ensuring the needs of vulnerable children are met and practical ways to improve virtual contacts during COVID-19 and beyond.

We are pleased to announce that our expert panel of speakers includes:
• Professor Viv Bennett CBE, Chief Nurse and Director Maternity and Early Years, Public Health England
• Dr Rosemary Singh, Specialist CAMHS Practitioner EPEC and Family Partnership Programmes / Clinical Psychologist, Centre for Parent and Child Support
• Gail Barker, Infant Feeding Coordinator, Devon Public Health Nursing

The webinar will also be recorded and will be available to iHV members on our website after the event, together with a FAQ sheet should we have a high number of questions.

Please join us.

How to book for iHV members

Go to our EventBrite booking page and please use your iHV membership number as your access code. If you have any problems or enquiries please email [email protected] and we will be happy to help.

Once you have submitted your details, you will be able to select your ticket and proceed to checkout – please note that this webinar is free to iHV members.

Go to EventBrite booking page

Previous iHV Insights

The great news is that recordings of all the iHV Insights webinars will be available for iHV members to access as a free member benefit after the event.

Click here to catch up on our 2 fabulous iHV Insights sessions so far:

21 May 2020 – COVID-19 in children and managing minor childhood illnesses
18 June 2020 – Domestic Violence and Abuse: Keeping victims and children safe during a pandemic

iHV launches updated COVID-19 professional advice for health visiting

Following the publication of the “COVID-19 restoration of community health services for children and young people: second phase of NHS response“ last week, we launch updated versions of the COVID-19 professional advice documents that were originally published in March. The documents have been developed in partnership with Public Health England, and have been signed off by them, to support the safe and effective delivery of health visiting practice during the restoration of the health visiting service during COVID-19.

The advice includes a clear statement on the redeployment of health visitors by Public Health England that:

“Where services have been interrupted this requires the restoration of elements of the service that were stopped, paused or reduced during the earliest phase of the pandemic and the return of any redeployed members of the health visiting team where this has been the case”.

The refreshed advice also includes the reinstatement of the 6-8 week postnatal review which is particularly important to ensure families are supported and perinatal mental health conditions are identified.

Additional safeguards to protect vulnerable children have been included with advice that “Face-to-face contacts should be prioritised for families who are not known to services, or those with safeguarding concerns, to mitigate known limitations of virtual contacts and support effective assessment of needs/ risks”.

We have also included additional information on the use of virtual contacts – their benefits as well as recommendations to minimise their limitations

Our suite of refreshed documents Delivering the Health Visitor Healthy Child Programme during the COVID-19 pandemic – Professional advice to support best practice include:

Please note: As the COVID-19 situation is rapidly changing, the information in these resources may change. Please keep checking the Government and NHS websites for details.

Also, don’t forget our COVID-19 webpages for health visitors and parents – see details below:

COVID-19 webpages

For Health Visitors– These new professional advice documents can be found on our COVID-19 (coronavirus) guidance for health visitors webpage – https://iHV.org.uk/COVID-19
For parents and families– The iHV is dedicated to supporting the health and wellbeing of all families and we are putting together links and resources from trusted organisations and websites to support parents and families during the COVID-19 pandemic – please see our Parenting through Coronavirus (COVID-19) webpage – https://iHV.org.uk/ParentingCOVID19

We have waivered our usual restrictions on resources for members so that the COVID-19 sections of our website are “free access” to all to support the national response to this pandemic.