As well as supporting health visitors, one of the iHV’s most important roles is to influence policies that affect the health of babies, children and families.  We do this in a number of ways – by working with policymakers and politicians across the UK and by raising the profile of what health visitors do, and its importance in a modern healthcare system.

We are fortunate to live in a time when we have more evidence than any other generation on the importance of getting it right in the earliest years of life – alongside supporting every child to reach their full potential, investing in these formative years also makes sound economic sense.

It is now time for the future government to step up to the plate to make “giving every child the best start in life” a reality!

Alongside tackling the wider determinants of health, all families should expect modern health services during pregnancy, the postnatal period and the earliest years of life that are on a par with the best in the world. Currently, families with babies and young children face a postcode lottery of support, health inequalities are widening, more children are falling behind with their development and are being harmed by conditions that are entirely preventable. Families are calling for better care.

On 4 July, voters will be going to the polls to decide which party they will trust with the leadership of our country, with health as one of the key issues.

The iHV is calling for a significant increase in the number of health visitors in England with three clear asks of the next government:

Policy: All families should receive the full offer of health visiting support as set out in national policy in the Healthy Child Programme and Health Visiting Model for England.


  1. Funding: All areas need sufficient funding to deliver the full specification for the national health visiting model and Healthy Child Programme Schedule of Interventions. Long-term investment, with ring-fenced funding, will help services to plan and build world-class services, ending the uncertainty of short funding cycles.
  2. Workforce: The national long-term workforce plan to retain, train and reform the health visiting workforce needs to be delivered in full, alongside funding for substantive posts. Demand-driven workforce modelling is needed to ensure that the workforce plan enables sufficient capacity to deliver the Healthy Child Programme to all babies, children and families as intended – it is estimated that 5,000 more health visitors are needed to meet the scale of families’ needs and replace workforce losses since 2015.
  3. Governance: Update OHID 0-19 Commissioning guidance – providing greater clarity and system levers to ensure equity of health visiting provision throughout England and ending the current postcode lottery of support that families face during pregnancy, postnatally, and through the first five years of their child’s life.

Key Messages:

  • Children born in England have some of the worst child health outcomes compared to other similar nations, with widening health inequalities, growing concerns about invisible vulnerable children, and soaring costs of late intervention. Tackling this requires a whole system response, including action to address the wider determinants of health. Action is also needed at an individual and community level to prevent, identify and treat problems before they reach crisis point. Health visitors provide an important part of the solution. When sufficiently resourced, they provide a vital infrastructure of support for families with babies and young children – with benefits that accrue across the health, education and social care system.
  • There are currently no levers to ensure that national policy set out in the Healthy Child Programme and Health Visiting Model for England are delivered. Families face a postcode lottery of support, with health visiting services experiencing significant cuts and role drift from their core “health” functions across numerous clinical pathways during pregnancy, postnatally, and throughout the early years. The needs of babies, children and families do not vary that much between local authority areas to justify the current variation in health visiting services across England.
  • Health visiting is the only service that proactively and systematically reaches all families from pregnancy and through the first five years of a child’s life. This provides support for all families across a breadth of physical health and mental health needs (for babies, children and adults), child development, social needs and safeguarding, and a vital safety-net for the most vulnerable that is not provided by any other service.
  • Cuts to health visiting services are having knock-on consequences across the health, education and social care system (for example, falling immunisation rates, fragmented postnatal care, increase in A&E attendance for children 0-4 years, inequalities in obesity rates, poor school readiness and soaring costs of late intervention/ child protection). Through their specialist public health role, health visitors can prevent, identify and work with families to treat problems before they reach crisis point.

Today, the First 1001 Days Movement, a coalition of over 200 charities and professionals, including the Institute of Health Visiting, published a ‘Manifesto for Babies’. The manifesto calls on all political parties to invest in prevention, demanding urgent support for vulnerable babies amid growing concerns about the health and welfare of Britain’s youngest.

The appeal follows last month’s warning from the Academy of Medical Sciences that the UK is “betraying” young children, by neglecting their essential physical and mental health needs.

The charities warn that a failure to act now will create “a ticking time bomb” that hits when children start school. The manifesto is published ahead of what is set to be the most crucial election for babies.

The manifesto recommendations include:

  1. An ambitious cross-government strategy to support babies’ healthy development, with a dedicated Cabinet Committee reporting directly to the Prime Minister, to ensure cohesive action.
  2. Sustainable funding for preventative services, including health visiting, and extending funding for the ‘Start for Life’ programme.
  3. Action to tackle health inequalities so that all babies have a good start to life – including targeted approaches to reduce inequalities and a commitment from the next government to tackle child poverty.
  4. Develop a workforce plan for children‘s social care and the early years, alongside delivering the NHS Long Term workforce plan.
  5. A rapid review of the tax and benefits system for parents and carers of under-2s, with increased paid paternity and parental leave, alongside training nursery staff on infant mental health

Local services are worried by the worsening health of the babies and young children they see:

  • Toddler development in England has declined over the last five years, with 1 in 5 two-year olds now below the expected level of development.
  • Slow development impacts on school readiness, with latest data showing 2.5 hours of teacher time is lost every day because children are not ‘school-ready’, and one in four children starting reception are not toilet trained.
  • The charities warn an estimated 10% of babies in this country are living in fear and distress because of disturbed or unpredictable care, and that one in five babies is missing the mandatory one-year old health visitor check where problems can be picked up early.

Evidence shows that the first 1,001 days of a child’s life, from pregnancy to age two lay the foundations for a happy and healthy life. The support and wellbeing of babies during this time is strongly linked to better outcomes later in life, including educational achievement, progress at work, physical and mental health.

Commenting on the “Manifesto for Babies”, Alison Morton, CEO Institute of Health Visiting, said:

“The next government must prioritise the health of our babies and young children. The current situation is deeply concerning as the health of our nation’s children has now plummeted to the lowest rankings amongst other comparable nations. Health visitors see the human face of these statistics every day. With more young children falling behind with their development and being harmed by conditions that are entirely preventable, there is a clear imperative to act.

“We urge all parties to listen to the collective voice of the First 1001 Days Movement coalition of more than 200 organisations captured in this manifesto. In particular, their call for urgent investment in health visiting to ensure that all babies and young children get the support that they need to thrive and to restore this vital safety-net for the most vulnerable.”

Keith Reed, Chief Executive at The Parent-Infant Foundation, said:

“Ignoring the needs of vulnerable babies leaves a ticking time bomb that hits when children start school. With the electoral battleground heating up, crucial services for babies hang in the balance. Start for Life cannot be allowed to suffer the same fate as Sure Start.  As babies can’t vote, it’s crucial that we speak up for them. Investing in babies’ wellbeing is not only the smart thing to do from a policy perspective, it’s a moral imperative.”

About the Manifesto for Babies

The Manifesto for Babies is published by the First 1001 Days Movement – a coalition of over 200 charities and professionals who believe that babies’ emotional wellbeing and development matters. Our members deliver a wide range of services that protect and support vulnerable babies and their families. These recommendations for UK policymakers are based on a survey of the First 1001 Days membership.

The Manifesto for Babies was developed by a Steering Group comprised of NSPCC, the National Children’s Bureau, Home-Start UK, the Institute of Health Visiting, the Anna Freud Centre, AiMH-UK, the Association of Child Psychotherapists, SANDS, Blackpool Centre for Early Child Development, Best Beginnings, Future Men, Approachable Parenting, Fatherhood Institute, Oxpip, the Parent-Infant Foundation and elected individual experts; Professor Eunice Lumsden, Bethany Boddy and Emma Carey.


The Institute of Health Visiting (iHV) publishes its findings from the largest UK survey of frontline health visitors working with families with babies and young children across the UK – “State of Health Visiting, UK Survey Report: Millions supported as others miss out”.

It’s deeply shocking that 93% of health visitors reported an increase in the number of families affected by poverty in the last 12 months. Poverty was the cause of greatest concern to health visitors. They visit the homes that families are struggling to heat and witness the impossible choices that parents are forced to make about feeding their children or paying the bus fare to attend vital health appointments. These struggles are often hidden behind front doors and invisible to other services until the situation reaches crisis point. Alongside an increase in poverty affecting families over the last 12 months:

  • 89% of health visitors reported an increase in the use of food banks
  • 78% an increase in perinatal mental illness
  • 69% an increase in domestic abuse
  • 63% an increase in homelessness and asylum seekers
  • 50% an increase in families skipping meals as a result of the cost-of-living crisis.

Only 3% of health visitors surveyed reported that families had not been impacted by the cost-of-living crisis. Some reported that poverty was so widespread that it had become the norm.

In our survey, health visitors also raised concerns about the wider impacts of poverty and increased parental struggle on children’s health, development and safety. The Government’s own data show that more children in England are falling behind with their development and health inequalities are widening. Worryingly, the situation is getting worse and showing no signs of recovery.

The good news is that health visitors saw millions of families last year, reaching significantly more babies and young children than any other health service or early years agency. However, despite health visitors’ best efforts, they are not able to meet the scale of rising need. Too many babies and young children are not receiving packages of support to improve their health and development when they need it, due to ongoing cuts to the health visitor workforce:

  • There is a national shortage of around 5,000 health visitors in England and families face a postcode lottery of support.
  • 79% of health visitors said that the health visiting service lacked capacity to offer a package of support to all children with identified needs.
  • Only 45% of health visitors were “confident” or “very confident” that their service was able to meet the needs of vulnerable babies and children when a need is identified.
  • 80% of health visitors said that other services were also stretched and lacked capacity to pick up onward referrals for children with additional needs. Thresholds for children’s social care support had increased and other services had long waiting lists.

Alison Morton, CEO at the Institute of Health Visiting, says,

“Consistently, health visitors have told us that parenting has become much harder for many families over the last 12 months. Health visitors are in a privileged position, they see firsthand the struggles that families with babies and young children are facing, often hidden behind front doors and invisible to other services. Sadly, despite policy promises, more and more children are not getting the “best start in life”. And the situation is getting worse with more children falling behind with their development and widening health inequalities. As babies can’t speak for themselves, health visitors provide a vital “voice” for our youngest citizens and an important warning signal for policymakers who are prepared to listen. It doesn’t have to be this way, change is possible.”

We publish at the start of a new year, with political and economic uncertainty, but also with hope as all political parties consider their plans to improve the health of our nation ahead of a general election expected this year. Our survey findings highlight the incredible potential and desire within the health visiting profession to support a brighter future for our nation’s children. But we cannot ignore the fact that the health visiting workforce is under significant pressure with unacceptable levels of work-related stress, as health visitors manage enormous caseloads, and escalating levels of need and vulnerability. We urgently need more health visitors.

Alison concludes:

“Our survey findings present a clear imperative to act. If we get the early years right, we can avoid so much harm later in life. The cuts to health visiting in England over the last 8 years have been a false economy. When sufficiently resourced, health visitors can take pressure off busy A&E departments and GPs, providing support for families in the heart of the community. The costs to rebuild the health visiting service in England are small compared to the spiralling costs of NHS treatment, child maltreatment and cumulative costs across the life course. Investing in our children’s health is not only the right thing to do, it also makes sound economic sense.”

To cite this report, please use the link to the pdf here:


Today, the Government has published their progress report on the Start for Life Vision and plans to extend Family Hubs, with a number of related publications for local authority areas, including:

  • A progress report on the best start for life vision written in consultation with Dame Andrea Leadsom MP, in her capacity as the Government’s early years advisor. The announcement confirmed the extension of Dame Andrea’s term as the Government’s early years adviser.
  • Confirmation that all 75 eligible Local Authorities (LAs) have successfully signed up to the £300 million Family Hubs and Start for Life programme announced in the autumn budget.
  • Confirmation of the announcement in the autumn budget of £10 million investment between April 2023 and March 2025 in innovative Start for Life workforce pilots in approximately 5 areas. These pilots will test ideas on how best to support the workforce to give babies the best start in life.
  • The names of 14 LAs who have been selected as trailblazer sites. These trailblazers will receive extra funding and will lead the way and support other local authorities to improve services that are offered to families, so that these can be rolled out more widely across the country.
  • Guidance for LAs on publishing their ‘Start for Life Offers’. Every local area is required to develop and make clearly accessible a coherent and joined-up Start for Life offer that sets out the support that families may need. Broadly, support will fall into 2 categories:
    • universal services – health visiting is listed as one of six essential services
    • additional, targeted or specialist services and support.
  • The funding also supports the establishing of local parent and carer panels, which will ensure that families are able to influence the improvement of Start for Life offers.
  • The names of the final five LAs enrolled on DfE’s £12 million Family Hubs Transformation Fund, building on the seven LAs that were announced last May.
  • Separately, Government is also confirming the final five areas to receive investment from the Family Hubs Transformation Fund, which will transition services which used to operate under the Sure Start banner over to the Family Hub model. This will enable a further 12 local authorities across England to open family hubs by March 2024.

Key documents published on 9 February 2023:

Other related guidance published in August 2022:


The Institute of Health Visiting joins leaders of health charities, medical organisations and health professionals (including the British Medical Association, British Heart Foundation and Cancer Research UK) in signing and sending an open letter to the Prime Minister expressing their profound concern that measures to promote children’s health may be abandoned without facing the scrutiny of Parliament.

This follows the Government’s recent review of its obesity strategy for England, which is understood to include plans to scrap the sugar levy on soft drinks and other measures to cut preventable illness such as the ban on TV advertising of junk food before 9pm – with the aim of ‘easing the UK’s cost-of-living crisis’.

The letter from the Obesity Health Alliance, signed by 70 organisations, is urging the new Prime Minister to reconsider any plans to weaken the public health measures put into place, which were supported by three previous Conservative government leaderships. This is especially pertinent given that in an average class of 30 year-six children, 12 will be living with overweight or obesity[1].

Alison Morton, iHV Executive Director said:

“The biggest threats to the health of our nation are linked to rising cases of non-communicable diseases (equivalent to 74% of deaths globally, WHO data) – and unhealthy diets remain one of the biggest preventable risk factors. It therefore makes no sense to reverse these well-evidenced public health measures which will bring long-term benefits for the sake of a short-sighted knee-jerk policy that fails to address the root causes of the cost of living crisis.

“Prevention is indeed ‘better than cure’; we therefore offer our full weight of support to this call on the government to take this seriously through the strengthening, rather than dilution, of their plans for public health.”

Without doubt, cutting preventable illness is crucial if the Government is going to tackle the NHS backlog, realise its targets to halve childhood obesity by 2030 and deliver on levelling up, as poor diet is a key driver of regional health inequalities.

This follows a survey (16 September 2022), carried out by YouGov for Cancer Research UK of more than 2,000 adults, which showed 60% of people support the junk food restrictions being implemented in January 2023 as originally planned.

Furthermore, the Soft Drinks Industry Levy (SDIL) has already demonstrated it’s an extremely successful policy that has reduced the amount of sugar in soft drinks by 30%, whilst increasing sales in the market (up 5% in 2021). In addition to removing 48,000 kilos of sugar from the nation’s diet, the SDIL has raised £300 million to fund over 2,000 school breakfast clubs and school holiday programmes, feeding a million children each year. It has also funded sports and PE equipment for primary schools. To stop collecting the SDIL revenues would lead to an increase in costs for families on lower incomes who vitally need these programmes.

Almost two-thirds of adult Britons are living with overweight or obesity. Obesity costs the NHS an estimated £6.1bn a year to treat because it is an increasingly common cause of cancer, type 2 diabetes, heart conditions, painful joints and other health problems. Government analysis projected that NHS costs attributable to overweight and obesity could reach £9.7bn by 2050.

Organisations and Individuals that have signed the letter:

  • Chris Askew, Chief Executive, Diabetes UK
  • Dr Charmaine Griffiths, Chief Executive, British Heart Foundation
  • Michelle Mitchell, Chief Executive, Cancer Research UK
  • Dr David Strain, Chair of Board of Science, British Medical Association
  • Dr Camilla Kingdon, President, Royal College of Paediatricians and Child Health
  • Dr Trudi Seneviratne OBE, Registrar, Royal College of Psychiatrists
  • Professor Kevin Fenton, President, Faculty of Public Health
  • Ben Reynolds, Deputy Chief Executive, Sustain: The alliance for better food and farming
  • Katharine Jenner, Director, Obesity Health Alliance
  • William Roberts, Chief Executive, Royal Society for Public Health
  • Prof Giles Yeo MBE, Professor of Molecular Neuroendocrinology, University of Cambridge; Honorary President, British Dietetic Association
  • Barbara Crowther, Coordinator, Children’s Food Campaign
  • Professor Graham MacGregor, Chair, Action on Salt and Sugar
  • James Toop, CEO, Bite Back 2030
  • Pamela Healy OBE, Chief Executive, British Liver Trust
  • June O’Sullivan, Chief Executive, London Early Years Foundation
  • Dr Linda Greenwall, Dental Wellness Trust
  • Kim Roberts, Chief Executive, HENRY: Healthy Start, Brighter Future
  • Rebecca Sunter, Programme Director, Impact on Urban Health
  • Hugo Harper, Director of A Healthy Life Mission, Nesta
  • Rachael Gormley, CEO, World Cancer Research Fund
  • Lorraine Tulloch, Programme Lead, Obesity Action Scotland
  • Dr Rebecca Jones, President, The British Association for the Study of the Liver
  • Alison Morton, Executive Director, Institute of Health Visiting (iHV)
  • Maria Bryant, Professor of Public Health Nutrition, University of York and Fix our Food
  • Ignacio Vazquez, Head of Health, ShareAction
  • Eddie Crouch, Chair, British Dental Association
  • Dr Matthew Philpott, Executive Director, Health Equalities Group
  • Professor Dame Helen Stokes-Lampard, Chair, Academy of Medical Royal Colleges
  • Anna Taylor OBE, Executive Director, The Food Foundation
  • Mike McKirdy, President, Royal College of Physicians and Surgeons of Glasgow
  • Dr Edward Morris, President, Royal College of Obstetricians and Gynaecologists
  • Dr Vicky Sibson, Director, First Steps Nutrition Trust
  • Professor Andrew Elder, President, Royal College of Physicians of Edinburgh
  • Professor Vinod Menon, President, British Obesity & Metabolic Surgery Society
  • Dr Nicola Heslehurst, Chair of the Board of Trustees, Association for the Study of Obesity
  • Michael Baber, Director, Health Action Campaign
  • Professor John Wass, Professor of Endocrinology, Oxford University
  • Rebecca Cooper, CEO, Children’s Liver Disease Foundation
  • Dr Adrian Brown, Chair, British Dietetic Association Obesity Specialist Group
  • Sarah Le Brocq, Director All About Obesity & Obesity Advocate
  • Kathy Lewis, Acting Chair, The Caroline Walker Trust
  • Professor Shona Hilton, Deputy Director, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow
  • Dr Fiona Donald, President, The Royal College of Anaesthetists
  • Martin Tod, Chief Executive, Men’s Health Forum
  • Professor Jim McManus, President, Association of Directors of Public Health (ADPH)
  • Lynda Phillips, CEO, British Association of Sport and Exercise Medicine (BASEM)
  • Mr Matthew Garrett, Dean, Faculty of Dental Surgery, Royal College of Surgeons of England
  • Professor Simon Capewell, University of Liverpool,
  • Professor Rachel Batterham OBE PhD FRCP, special adviser on obesity, Royal College of Physicians
  • Dr Marissa Smith, Research Assistant, MRC/CSO Social and Public Health Sciences Unit (SPHSU), University of Glasgow
  • Rob Percival, Head of Food and Health Policy, Soil Association
  • Professor Amandine Garde, Law & NCD Research Unit, University of Liverpool
  • Professor Sir Stephen O’Rahilly, Director, Medical Research Council, Metabolic Diseases Unit, University of Cambridge
  • Prof Jack Winkler, Professor of Nutrition Policy, London Metropolitan University (Retired)
  • Feng He, Professor of Global Health Research, Queen Mary University of London
  • Sarah Turner, Chair, The Breastfeeding Network
  • Professor Laurence Moore, Director, MRC/CSO Social and Public Health Sciences Unit
  • Neville Rigby, convener, International Obesity Forum
  • David McColgan, Chair, NCD Alliance Scotland
  • Stephanie Slater, Founder/ Chief Executive, School Food Matters
  • Professor Sir Nicholas Wald, University College London
  • Tam Fry FRSA, Patron of Child Growth Foundation and Chair of National Obesity Forum
  • Carina Millstone, Executive Director, Feedback
  • Patricia Marquis, Director, Royal College of Nursing
  • Professor Alexandra Johnstone, Association for the Study of Obesity Scottish Network
  • Sheila Duffy, ASH Scotland
  • Professor Sadaf Farooqi, Professor of Metabolism and Medicine, University of Cambridge
  • and Scientific Advisor, Obesity Empowerment Network
  • Jill Muirie, Chair, Glasgow Food Policy Partnership
  • Phil Pyatt, CEO, Blood Pressure UK




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

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:

  • 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.”