Today, as announced by Sally Hogg during her presentation at the iHV Evidence-based Practice Conference 2021 (#iHVEBP2021), iHV together with the First 1001 Days Movement is launching our #TurnOffTheTaps campaign calling for investment in Health Visiting services.

#TurnOffTheTaps campaign

The focus of Government policy and spending is too often on dealing with a backlog of unmet needs, rather than reducing this need through improving the health, happiness and resilience of our citizens. We are investing billions in overstretched health and social care services, which are flooded with growing needs. It’s time for a different approach. It’s time to turn off the taps. It’s time to invest in health promotion and prevention in the earliest years of life.

The Chancellor has said that the Spending Review, announced this autumn will ensure “strong and innovative public services” and level up across the UK to “increase and spread opportunity.”

Investing in services that give children the best start in life reduces demands on GPs, hospitals and social care. It means children start school ready to learn and to achieve, so our schools can be more effective. Investing at the start of life gives our children the best chance of being safe, happy and healthy throughout their lifetime and into old age.

Science shows us that action in early life can prevent problems that can be costly to individuals and society. Economics shows that investment at the start of life generates the greatest returns.

We are calling for investment to deliver the Government’s Start for Life Vision. This includes a £500 million ringfenced uplift in the Public Health Grant over the next three years. This will enable local authorities to create strong and innovative Health Visiting services able to play their role in increasing opportunity for our citizens and reducing long-term burdens on the NHS.

Alison Morton, Executive Director iHV, commented:

“I am delighted that so many organisations and individuals have joined alongside the iHV, as part of the First 1001 Days Movement, calling for investment to deliver the Government’s Start for Life Vision and increase the number of health visitors.

“We hear daily how the NHS is flooded with growing need – now is the time to #TurnOffTheTaps.

“The evidence is clear that investing in the earliest years of a child’s life is the smartest of all investments – we don’t need any more evidence for this. It is time to stop admiring the problem and invest in the infrastructure of support that will actually make the difference.

“We urge all health visitors to join this campaign and speak out about the vital work that they are doing. We would also like to thank all of our partners for their unwavering support.”

What is the #TurnOffThe taps campaign?

It is clear that reducing short term burdens on the NHS is a priority for the Government. Therefore our campaign focuses on how investment in health visiting can reduce demand for NHS services.

Our Health Visiting Ask

  1. We are calling for investment to deliver the Government’s Start for Life Vision, including improvements in parent and infant mental health services, breastfeeding, maternity and health visiting services.
  2. This includes a £500 million ringfenced uplift in the Public Health Grant over the next three years which would enable growth in health visitor numbers and strengthening the leadership in health visiting services.
  3. We are calling on Government to invest enough to reach a total of 5000 new health visitors over the next 5 years, with 3000 in this spending review period.
  4. In addition to the extra health visitors, the £500 million includes funding to increase the leadership capacity in health visiting service. This additional capacity would enable service leaders to drive excellence in practice through workforce development, research, service innovation and strong integration with other services.

How can you get involved?

The most important thing you can do is to tell your story. Get on social media and/or contact your MP and share YOUR stories about how health visitors give children the best start in life and can help to reduce demands on the NHS.

To support this campaign, you can:

  1. Share the calls to action on social media  – please see hashtag #TurnOffTheTaps
    • Please share content about the campaign from Wednesday 22 Sept onwards and increase activity around the 30 Sept, but please share your own stories too!
  2. Send a letter to your MP
    • Tailor the letter template and send it to your local MP. Tailor the letter to your local context. Perhaps explain what you do and invite the MP to visit your service; give a case study to show the work of local health visitors and/or talk about local cuts to services.
    • Please include the campaign briefing with the letter when you send it.
    • To find your local MP’s details go to https://members.parliament.uk/FindYourMP

What the First 1001 Days Movement is doing

In addition to the materials to support you as above, the First 1001 Days Movement will:

  • Submit a formal representation to Treasury.
  • Write to Maggie Throup the new Public Health Minister
  • Try to secure press coverage for the campaign

What iHV is doing

Further to above, the iHV will also be submitting our response to the Spending Review on the 30 September with a consistent ‘ask’ of the Government to invest £500m in health visiting from across the sector.

 

 

Health visitors across the UK have expressed their widespread disappointment at the Government’s dismissive response to a recent petition calling for reinvestment in health visiting. The petition was set up by health visitors in Hampshire who were concerned that the proposed cuts to their service, and many other local authorities in England, would knowingly cause harm to babies and young children, and leave families without the support they need.

The Government’s response to this petition has been labelled a ‘whitewash’ by many as it fails to take these concerns seriously, stating: “Local authorities are best placed to make decisions for their communities… Local delivery models vary, as services are tailored to meet local need… We do not advocate a specific health visitor staffing number or case load. This is because it should be led by health needs of a population.”

Lesley Tarling, the health visitor in Hampshire who set up the petition, says:

“I’d like to thank the Government for their response to our petition. However, it is disappointing that the core question in our petition remains unanswered. Funding cuts have inevitable consequences, health provision to the young will be irreparably affected. Health issues will be missed, and Adverse Childhood Experiences accentuated”.

Has need gone down? Do some areas not need a robust health visiting service? On the contrary, the evidence is clear that vulnerable babies, young children and families live in every postcode in the county, and many of the challenges they face are not socially correlated. With widening inequalities in England, a poor state of child health, more families tipped into vulnerability due to the pandemic, and a backlog of children not seen face-to-face, health visitors are needed more than ever to ensure that babies and young children at risk of poor outcomes are identified, and that families are supported at the earliest opportunity.

It will be a while before we know the full impact of the pandemic, what is clear is that need has definitely not gone down. Many health visitors are reporting that they are concerned that they are only reaching the “tip of the iceberg”, with research highlighting increased demand across the breadth of health and social needs.

Health visiting entered the pandemic in an already depleted state following a 31% reduction in health visitors in England since 2015, with more local authorities planning further cuts due to budget deficits. 80% of health visitors now manage caseloads above the recommended number of 250 children per health visitor (almost one-third have more than double this amount, and 12% have over 700 children). As a result, families face a postcode lottery of support – it is clearly impossible for a single health visitor to provide the personalised care that parents want, and that the Government recognises as central to effective outcomes. With such unmanageable caseloads, no amount of delegation or ‘digital light touch offer’ can detract from the key governance issue that a single health visitor will be responsible for overseeing, planning, reviewing and supervising the care of such large numbers of children.

Should local areas decide? Whilst there are some excellent examples of effective services, the petition response ignores the current “Wild West” of health visiting which cannot be ignored. The Government’s own Early Years’ review reported that families are being let down by poor quality services in some areas with findings published in March highlighting: “workload pressures… meant it was hard for dedicated professionals and volunteers to support families in the way they wanted to and, sadly, the Review also heard examples of instances where families felt let down by the services they received”. 

What would babies and young children say? They are citizens with their own needs and rights that are easily overlooked without the universal safety net that a robust health visiting service provides.  Sadly, 285 children were killed or seriously harmed in the first 6 months of lockdown; of these, 35.8% were babies under 1-year of age. Babies under the age of one also remain at the highest risk of homicide compared to any other age group. Our most vulnerable members of society cannot ask for help, they rely on others to advocate for them. Whilst many parents can advocate on behalf of their baby or young child, sadly in some instances, parents cannot care for their child and lack the agency to reach out for help when needed. It is therefore vital that an effective, statutory, universal health visiting service is provided in all areas – this cannot be left to chance.

When we recently challenged these serious incident and child death figures, we were offered the platitude that although the figure had increased this year, it was not extraordinary as it had been almost as high in 2018/19!!! Does this make it acceptable? Each one of these children represents another “Baby P” or “Victoria Climbié” – they have paid the ultimate price and been let down the most. We need to do better, not worse. Yet, the health visiting service intended to identify and support vulnerable babies and young children faces ongoing cuts, a shift to non face-to-face contacts, and outcomes reduced to ‘bean counting’.

We cannot say we didn’t know – the Government’s lack of action sends a powerful message that the current state of affairs is acceptable.

Look beyond the misleading and superficial process outcome data: The Government’s petition response states that:

“most recent data available on health visitor service delivery in England shows that a high proportion of infants received mandated health reviews in 2019/20:

  • New birth visits completed: 97.5%
  • Proportion of infants receiving a 6 to 8 – week review: 85.1%
  • Proportion of children receiving a 12 – month review: 77.0%
  • Proportion of children receiving a 2 -2 ½ review: 78.6%.”

It is important that we keep the needs of the child at the centre and are not misled by this ‘whitewash’ of process outcome measures which overlook important quality metrics. What this data does not show:

  • A postcode lottery of health visiting support with some families reporting that they haven’t seen a health visitor face-to-face for over a year.
  • Many of these reviews are not completed by qualified health visitors now. In a recent survey by the Institute of Health Visiting, only 17% of 1-year reviews, and 10% of 2-year reviews, were completed by a qualified health visitor.
  • To cut costs, some areas are now completing these important universal assessments with a postal or telephone contact despite evidence warning that this practice is unsafe and introduces unacceptable risks – it ticks the box, but misses the point: Needs change over time – it is therefore imperative that ALL 4 mandated reviews that children receive between birth and 2.5 years are completed face-to-face (we need to get this right, it is such a minimal ask). It is clearly impossible to complete an accurate holistic assessment of a baby or young child without physically seeing them, the subject of the assessment. The lack of national standards for these reviews and the Government’s knowing acceptance of the dangers inherent in this ‘local flex’ is causing harm; vulnerable children and serious health conditions will continue to be missed unless addressed. Virtual contacts have a place in a modern healthcare system, but they should not be used for universal reviews and should only be used when it is safe to do so and they enhance quality of care.
  • Whether the contacts actually made a difference: The universal contacts are a  gateway into health visiting support and will only be effective if the service has sufficient capacity to act on identified needs and provide the intensity and quality of support needed to make a difference.

Investment in babies and young children and preventative public health: The petition response states that the public health grant to local authorities in England will increase from £3.279 billion in 2020/21 to £3.324 billion in 2021/22, an increase of 1% in cash terms. However, this represents a cut in real terms. Public health grant allocations have fallen in real terms from £4.2 billion in 2015–16.  On a per head basis that equates to a 24% cut since initial allocations were made in 2015–16 (Health Foundation analysis).

At a minimum, the Government should restore the grant to 2015/16 levels by investing an extra £1 billion a year and then ensure that the grant keeps pace with growth in NHS England’s spend and covers the costs of implementing the Early Years’ review recommendations in full. We have estimated that in order to rebuild the service and ensure that all families receive the support they need, an additional 5,000 health visitors are needed in England.

This situation is reversible but needs political will. Children’s needs should now be prioritised in the manner that those of adults were during the pandemic. The proposed cuts should not be allowed, earlier reductions in children’s services should be reversed, and the welfare of babies, children and young people should be put at the centre of all policies for civil society.

We emphatically do not suggest that the problems described are intended outcomes, but without any changes, many leading stakeholders agree that state harm will come to be the phrase used to describe them.

Read the full response to the petition here: https://petition.parliament.uk/petitions/589522

  • iHV joins a coalition of early years charities to warn government they’re at risk of failing a generation of babies born during the coronavirus pandemic.
  • Joint Statement on the future of public health in England – giving every child the best start in life.

In a Joint Statement on the future of public health in England, the iHV, alongside nine expert early years charities, put their eight principles to Matt Hancock which must be considered when looking at health visiting. The organisations are urging Government to recognise there is a timely opportunity to rebuild the nation’s public health services for children and families.

The coalition of early years charities consists of Action for Children, the Association of Child Psychotherapists, Best Beginnings, First 1001 Days Movement, Home Start, OXPIP, the Institute of Health Visiting, NCB, NSPCC and the Parent-Infant Foundation.

NSPCC sent the Joint Statement together with an open letter to Secretary of State for Health and Social Care Matt Hancock, saying that England’s health visiting programme is not equipped to meet the challenge of the Coronavirus pandemic, and must be rebuilt according to eight principles developed by the group of early years experts.

Dr Cheryll Adams CBE, Executive Director the Institute of Health Visiting, said:

“We are delighted to be part of this important coalition sharing our joint position on the need to return investment to the health visiting service so that it may fully play its part in ensuring that all parents have the support they need. Then, and only then, will every baby have the opportunity for the best possible start in life.”

The Pandemic has also seen restrictions to the service and redeployment of health visitors, which have resulted in many families not receiving their entitled health visits. According to the Babies in Lockdown report, produced by Best Beginnings, Home Start UK and Parent-Infant Foundation, just 1 in 10 parents with children under two saw a health visitor face-to-face during the pandemic.

The organisations have long warned Government about the history of cuts to public health funding and the significant decline in NHS health visitors, which meant the service struggled to support families across the country even before the pandemic.

The letter, backed by over 2,000 members of the public, highlights that the restructure of Public Health England must prioritise giving every child a fair start in life.

Led by health visitors, all families in England are entitled to receive five check-ins from qualified health visitors via the Healthy Child Programme. However, NSPCC research with over 2,000 mothers in England, conducted with YouGov prior to the pandemic, found only 6% had been supported by the same health professional throughout the perinatal period. One in four mothers had reviews conducted via letter, text message, or a phone call instead of in-person support.

Whilst Public Health England recently announced that health visitors should not be redeployed over the winter, research by UCL found that in some areas of England, as many as 50% of staff were redeployed during the first phase of the pandemic.

Since April, the NSPCC’s helpline has received 1,897 contacts from adults concerned about parental mental health, with over half being referred for further support. The monthly average number of contacts post-lockdown has increased by over a third (34%) when compared to the average for January to March.

Dr Adams commented:

“Over the past five years we have seen an average 30% reduction in the number of health visitors in England, accompanied by a massive variation in these losses across the country. The average health visitor caseload is now 500 children, double the recommended number.

“The number of invisible vulnerable babies will have increased and perinatal mental illness is already reported by health visitors to be ‘sky rocketing’.

“The whole population will also be paying the price – the erosion of the health visitor role results in kicking the can down the road where the impact is picked up by other much more costly services. We urge the Government to listen to the voices of parents, charities and health professionals now and take urgent action to reinstate a robust health visiting service before even more damage is done.”

The NSPCC is inviting people to join the thousands who have already raised their voice and signed the Fight for a Fair Start petition.

 

The Institute of Health Visiting has provided the Treasury with the latest evidence and cost benefits for new investment into health visiting as part of its Comprehensive Spending Review.

As the Institute submits its evidence to the Spending Review, Dr Cheryll Adams CBE, Executive Director iHV, said:

“We hope that this clear rationale and evidence for investing into the early years through the health visiting service will be taken seriously when the Treasury reviews all the submissions. There has never been a greater need to act to support young families as they face the secondary impacts of the COVID-19 pandemic. A loss of 30% of the health visiting workforce, since cuts to public health budgets, is impacting on our most vulnerable citizens and their families, but this will also have a significant long-term legacy for the country as a whole.”

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).

See also iHV responds to Petitions Committee report: impact of COVID-19 on maternity and parental leave

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.”

 

The Petitions Committee has today launched its landmark report calling on the Government to extend parental leave and pay for all new parents affected by COVID-19.

More than 226,000 people have signed an e-petition calling for the Government to extend maternity leave by 3 months with pay in light of COVID-19. The committee received over 69,000 responses with people sharing their experiences and views on the Government’s response and on the actions they think need to be taken.

But the Government’s response to this petition to date has been to turn down petitioners’ requests for more time. The Committee has heard from new parents who have found that their jobs are at risk as they are unable to find childcare, from parents whose mental health has been severely affected, and from parents who are desperate for help and support. In addition, Dr Cheryll Adams appeared before the House of Commons Petitions Committee in May to talk about the petition – she contributed some evidence and raised the profile of the work of health visitors during COVID-19 – see news story here.

Dr Cheryll Adams CBE, Executive Director, iHV, commented:

“This enquiry has demonstrated government and democracy at its best, with the views of the population, in this case new parents, being truly listened to. Young families have received little attention during the response to the COVID–19 pandemic but the Institute has reported that their needs, as a result of lockdown, could form a secondary pandemic if not addressed quickly.

“As families start to surface again, we are now hearing evidence of the impact of the past three months in lockdown on families, with an increased incidence of safeguarding issues (more domestic violence), more infants going into care. Health visitors are also reporting an explosion of mental health issues, especially for our most vulnerable families including those who have fallen into poverty due to job losses, or who may have had children with special needs or prematurity.  Many others are worrying about their return to work as evidenced by the enquiry. The loss of easy access to the normal support services, and to opportunities to maintain their social and emotional wellbeing through meeting with family and friends has been profound.

“We recommend that the Government listens to the overwhelming evidence gathered from parents and experts in the early years by this enquiry committee. It must act now to provide additional support, especially to those needing to return to work in the next few weeks/months, but also respond to the clear evidence that this stage of everyone’s life trajectory needs to be taken much more seriously by the Government. Ultimately all the evidence is clear, doing so will lead to many future financial and social benefits for the country as a whole.

“An urgent first step is to do a workforce review of the health visiting service, provide new funding to replace the huge numbers of health visiting posts which have been allowed to be lost since 2015, and address the inconsistencies in the health visiting services that parents can access up and down England. The Institute has already published its own Vision for how this should be done.”

 

 

The report finds that there are many more areas where the Government needs to consider taking urgent action, including access to free dental treatment for new mothers, access to rapid COVID-19 testing for parents with babies in neonatal care, and the extension of protections for women against losing their jobs as a result of being pregnant or a new parent.

 

 

Key findings and recommendations made in the report include:

  •  New parents have missed out on crucial support, the lack of which could have a huge impact on their mental health and that of their children, with resulting impacts on the NHS and the UK economy
  • The Government should extend parental leave and pay for all new parents affected by the pandemic. This includes maternity leave, shared parental leave and adoption leave
  • The Government should publish clear new guidance for employees and employers on supporting pregnant employees and those returning from parental leave that explains clearly their options and responsibilities
  • The Government should consider extending the period in which pregnant women and new parents may bring claims before the employment tribunal to 6 months from dismissal in light of current challenges posed by Covid-19
  • Free dental care is an important benefit that most pregnant and new mothers have been unable to access as the result of the pandemic. The Government should extend maternity dentist provision for new and expectant mothers affected by the pandemic for at least six months
  • The Government should review the provision of health visitor services in light of Covid-19 and consider funding increased numbers of health visitors and other allied professionals, to ensure that vulnerable families are identified and given the support they need
  • The Committee strongly urges the Government to follow the science and stay alert to how the Government supports new parents so that the effects of the pandemic do not continue to impact families for years to come

 

Over the past few days many of you have supported us in our preparation of a briefing for MPs for the Parliamentary Debate on health visiting cuts which took place on Wednesday afternoon (23 October). If you weren’t able to watch the debate at the time, we have the link here:

If you haven’t yet had time to look at our blueprint Vision for the future of health visiting (Health Visiting in England: A Vision for the Future), please do read it – you are going to be hearing a lot more about it. It has attracted incredible support from those who truly can make a difference and it was very encouraging to hear Jo Churchill, Parliamentary Under Secretary of State for Prevention, Public Health and Primary Care, referring to it, and stating her desire, during the debate, to meet with us to discuss it.

When we meet with Jo Churchill, we will be taking with us the results of our latest State of Health Visiting survey. Thank you to those of you who have already completed it, and some of your anonymous comments have already been shared.  But we do need a good sample size to make the findings robust. So, health visitors, please do take the time to complete it as we will continue to use the aggregated data in our ongoing lobbying of government and will be publishing the survey report at our Leadership conference on 3 December – you are welcome to join us for this inspiring day. Tickets are selling fast so don’t miss out!

The link to the survey has been shared out via email to health visitors, however, if you cannot locate it, please contact [email protected] to request the link.

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.”

Today, the Department for Education launches their new campaign Hungry Little Minds which provides valuable information and resources for parents to boost their children’s language and literacy development with fun, everyday activities.

This welcomed campaign responds to the compelling evidence that early language is a primary indicator of child well-being. Health visitors are well aware that the early years provide a critical opportunity for building healthy, resilient children, with positive early experiences shaping outcomes throughout the life-course. Crucially, the resources recognise the most important role that parents play in their child’s development – particularly their language development, which starts before birth and is significantly shaped in the earliest years of life.  Health visitors are ideally placed to support the reach of these important messages through their crucial work with parents and children as part of the Healthy Child Programme.

The three year Hungry Little Minds campaign, launched with social media and online adverts, aims to help parents understand that they have a massive impact on their child’s learning and that reading, playing and chatting with them is a simple thing they can do to help them develop even when they are too young to say much back. The campaign provides lots of simple tips and activities that parents can slot into their routine and that children love.

Parents can access tips and activities from https://hungrylittleminds.campaign.gov.uk/ and also search for activities in their area using a new postcode finder service.

The Institute of Health Visiting fully supports today’s call by The King’s Fund and the Health Foundation for a reversal to cuts made to public health funding.

We endorse their call for an urgent review of the public health allocation as part of the expected roll-over grant in place of the anticipated full Spending Review. In particular, we call on the Treasury to carefully consider the wealth of evidence and benefits to society and the public purse from investment in supporting families during the crucial first 1000 Days of Life. Our children are this country’s greatest asset for the future, yet disadvantage and inequalities start early and can last a lifetime if not addressed. Recent year-on-year cuts to the public health grant are having an irreversible impact on our most disadvantaged children. These children cannot wait any longer for decent policies to ensure every child has the best start in life, with sufficient national levers and budgets to support full implementation. We are calling for action now, and our case for a strengthened health visiting service is set out in our recent letter to The Rt Hon Elizabeth Truss MP, Chief Secretary to the Treasury.

We fear that the damage done in the last 3 years will take many more to correct without urgent action now.  It is fundamentally and morally very wrong that it’s been necessary to cut child health clinics and easy access to health visiting services in many areas of the country and, in so doing, the support they once provided for thousands of parents. Prevention and early intervention is often described as “turning off the tap rather than mopping the floor”. This is essential if we are to tackle key priorities like childhood obesity; infant, child and perinatal mental health problems; falling immunisation rates; and soaring unnecessary A&E attendances in the under-fives that could so easily be addressed with better early support and opportunities for parents to talk about their worries with a trusted professional. There are now massive variations in the type of service that health visitors can offer parents up and down the country, with minimal services most often the norm.

We too call on the Treasury now to fulfill their responsibility to the public by once again investing in public health and early preventative interventions for families.