Yesterday, the iHV submitted its policy proposals to the government’s Spending Review making the case for rebuilding health visiting services in England. The Spending Review provides an important opportunity for professional bodies to influence government spending over the next three years. The government has stated that they will use the Spending Review to change the way public services are delivered by embedding a mission-led approach, driving forward public service reform and making the best use of technology to better deliver services.

Our response brings together the collective voice of health visitors captured in our annual survey and the wider work of the Institute, outlining the poor state of child health and rising levels of need experienced by babies, children and families that cannot be ignored any longer. We are delighted that our call for investment in health visiting has attracted widespread support from across the child health and early years sector – the message is clear, we need more health visitors!

To improve our nation’s health and reduce pressure on NHS services, much greater attention needs to be given to prevention, early identification of health needs, and early intervention in the critical earliest years of life. Health visitors have a vital role to play as part of the “health” workforce, contributing to multiple clinical pathways through pregnancy, the perinatal period, and 0-5 years (for babies, children and adults).

It is therefore vital that the “broken” state of health visiting is addressed, alongside the NHS, with action to reverse the loss of more than 40% of health visitors since 2015. The cuts to health visiting services have been a false economy, impacting on families’ quality of healthcare and placing additional burdens and costs on other parts of the healthcare system.

Our request aligns with the government’s objectives to prevent ill-health by improving child health, and reform health visiting to reduce spiralling costs of late intervention. Our brief summary sets out our policy proposal:

  • To address the loss of more than 40% of health visitors (HVs) since 2015 and ensure all families receive support in line with the Healthy Child Programme, ring-fenced funding is needed for 1,000 extra HV posts each year for the next 3 years.
  • To reform health visitor services and support workforce retention, salary uplift funding is needed for 689 specialist HV posts (providing clinical leadership for government priorities, like perinatal mental health, immunisations and SEND).

Benefits and policy rationale

More health visitors are needed to deliver the government’s ambitions for prevention and early intervention (across health, education and social care), including reducing children’s A&E attendance and improving immunisation uptake, the quality of postnatal care, and early identification and support for “school readiness” and SEND.

Deliverability of proposals: It is far easier to rebuild and reform a tried and tested service like health visiting than invent a new preventative health workforce, with all the regulatory and training infrastructure needed for quality assurance and to protect the public. We welcome the government’s commitment to “reform health visiting”. This will require actions to improve workforce capacity, recruitment and retention.

Costs:

  1. Costs of 1,000 more health visitor posts are £52.9m for year 1, £105.8m for year 2, and £158.7m for year 3.
  2. Salary uplift costs for 689 specialist HV posts are £8.64m per annum (from band 6 to band 7).

We submitted our brief policy summary online on 10 September, alongside our supporting information and costings – available here.

iHV welcomes the publication of the Early Intervention Foundation’s report – Adverse childhood experiences: What we know, what we don’t know, and what should happen next.

 

This report surveys the evidence relating to the prevalence, impact and treatment of Adverse Childhood Experiences (ACEs), the extent to which ACEs should provide the basis for frontline practice and service design, and the known level of effectiveness and value of ACE-related approaches, such as routine enquiry and trauma-informed care.

 

 

Commenting on the launch of Adverse childhood experiences: What we know, what we don’t know, and what should happen next, Dr Cheryll Adams CBE, Executive Director of the iHV, said:

“This report will add real value to the current interest in ACEs, pointing out as it does their limitations as well as their benefits in understanding the impact of adversity in childhood and into later life. Its publication, in the same week as Sir Michael Marmot’s 10 Years On update report on health inequalities, adds urgency to the recognition of the adverse experiences of so many children as a result of an more unequal society as well as their individual circumstances.”

iHV responds to Local Government Association (LGA)’s analysis on children’s social care, published today, which calls for Government to use the upcoming Spending Round to fully fund the demand on children’s services next year to allow councils to provide the vital support that children and families rely on.

Severe funding shortages and huge demand pressures mean councils were forced to overspend on their children’s social care budgets by nearly £800 million last year in order to try and keep children safe, the Local Government Association reveals today.

Dr Cheryll Adams CBE, Executive Director iHV, commented:

“The Institute has long warned that more children entering safeguarding procedures and care would be an inevitable consequence of cutting preventive services such as health visiting which identifies needs in families early, mobilises support for families in need and reduces long-term negative consequences of late identification for these children, such as safeguarding issues and care proceedings. These new figures should be of concern to the whole population as, as well as negatively impacting on the child his/herself and their potential future, these high levels of vulnerable children impact crime rates and criminal justice budgets and increase demand on the NHS from complex health needs.

“One in three health visitors has been lost over the past 4 years and the imposition of unhelpful new ways of working makes it impossible for the profession to adequately offer the necessary long term support that some families need. Alongside the LGA, we also call on the Prime Minister and Treasury to use the upcoming spending review to reinvest into public health, preventative and children’s services. The economic arguments are clear.”

iHV supports the call by the Early Intervention Foundation for more investment into Early Intervention in England, following the publication of its report, Realising the potential of early intervention. This report sets out a bold plan of action to ensure effective early intervention is available to the children, young people and families who need it most.

Dr Cheryll Adams CBE, Executive Director iHV, said:

“The Institute of Health Visiting supports the call by EIF for more investment into Early Intervention in England. We would like to see this extended to research and investment into whole universal systems change, as well as individually focused approaches. For example, health visitors are alarmed by seeing current cuts to their services resulting in many more vulnerable children having their needs recognised late, and needing much more complex and expensive interventions, than if their families had received sufficient early support that health visitors could once offer.”