If you missed yesterday’s All Party Parliamentary Group (APPG) for Conception to Age Two meeting held online, you can watch it on the link below.

Yesterday’s APPG meeting was chaired by Tim Loughton MP, and the topic was ‘Midwives, Health Visitors and Family Hubs’. Alison Morton, Executive Director iHV, gave evidence on the challenges and opportunities facing health visiting – you can listen to Alison at 1:10:52 until 1:23:00.

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

If you missed yesterday’s All Party Parliamentary Group (APPG) for Conception to Age Two meeting held online, you can watch it here (click on the image below to go to YouTube):

 

Held as part of Infant Mental Health Awareness Week and chaired by Tim Loughton MP, this APPG meeting focused on local variation in the provision of services for babies and their families across England, and how this might be addressed through current reforms – it also includes a presentation from iHV’s Executive Director, Alison Morton, on unwarranted variation in health visiting in England.

Our colleague, Melita Walker, joined the virtual sofa on BBC Look North news programme yesterday evening.  You can watch the clip here (available on BBC iPlayer only until 7pm this evening).

This news item was in response to the growing number of calls from anxious new mums giving birth in lockdown. During the programme, they catch up with BBC Look North’s own mum to be, Kelley Donovan, who speaks to Melita about what to expect and easing concerns

Please watch from about 11.10 into the programme.

iHV’s Melita Walker joins the virtual sofa on BBC Look North

The Institute of Health Visiting (iHV) is delighted to publish ‘Health Visiting in England: A Vision for the Future’, their evidence-based blueprint to rebuild health visiting services.

Developed in response to the government’s request for stakeholder engagement to inform their plans to refresh the health visiting model for England and the Healthy Child Programme, and taking into account the worrying loss of health visitors over the past 4 years, this publication sets out a new model of health visiting advising eight universal contacts and a particular focus on fifteen areas where health visiting can have a high impact on health outcomes.

 

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

“Despite overall improvements in child health, England lags behind other countries on many key health outcomes: infant mortality reductions have stalled, our breastfeeding and obesity rates are amongst the worst in Europe, our immunisation rates are falling and health inequalities are seen across all indicators.

“The current status of health visiting is not serving families well, based as it is on universally delivered process outcomes which risk “ticking the box, but missing the point”. There remains a persistent gap between what the evidence tells us, and the profession aspires to achieve, and what is currently able to be funded and provided since the year on year cuts to public health budgets starting in 2015.

“Based on the evidence, we recommend that the universal offer in England includes three additional service “review points”, increasing the offer to eight contacts, with additional tailored support where needed, aligned primarily to fifteen High Impact Areas where health visitors can make the greatest difference to infant, children and family outcomes. But also recognising the value of health visiting in, for example, supporting the mother postnatally to manage on-going physical consequences of giving birth, supporting the family of a child who has a chronic and worrying health issue such as asthma, supporting families through a bereavement or working with a people within marginalised groups.”

Health Visiting in England: A Vision for the Future

The new iHV Vision for Health Visiting in England sets out an “upstream” public health response with action based on the principles of proportionate universalism. It seeks to address some of the limitations of the current 4-5-6 model, balancing the need for a population approach alongside a more personalised individual response.

In addition to renewed investment and revised workforce modelling, a plan for rebuilding the workforce will be needed to establish the workforce requirements to deliver a refreshed Healthy Child Programme and all levels of the health visiting service offer.

 

Dr Adams continued:

“National leadership by government is essential to set ambitious and binding national goals to reduce health inequalities for children in key public health priority areas.

“The health visiting service of the future needs to be built more closely around eight key elements to ensure the service is: evidence-driven, accessible, responsive, personalised, collaborative, fairer and effective. This will only be achieved with greater professional autonomy and a recognition of the importance of relationships at the heart of everything we do.

“We need action today, to support every child to have the best start in life and a ‘bright’ future.”

 

Follow and support #FutureofHV on social media.

Top perinatal mental health psychiatrist and Chair of the Maternal Mental Health Alliance speaks up for health visiting!

Dr Alain Gregoire spoke up for health visiting on the Radio 5 Live 6am programme yesterday, and voiced his concerns regarding the impact of the cuts to posts on the services that health visitors can offer mothers suffering from perinatal mental illness.  Find his interview here at 6:13 on 30th April.

This week is Maternal Mental Health Week, follow the action on Twitter @iHealthVisiting.

new parents with their health visitor

 

“Making a difference through leadership”

‘Making a difference through leadership’ is our next Leadership Conference, being held in London on Tuesday, 5 December 2017, so please do hold the date!

Don’t miss out on a fantastic opportunity to attend the iHV’s annual leadership conference, followed by our annual celebration event.

Full programme details will be announced shortly with leading speakers and experts, and peer-to-peer networking opportunities.

This is a MUST ATTEND event for health visitors, iHV Fellows, service leads, public health commissioners with limited places also available for SCPHN Students.

Delegate places will shortly be available to book from £125 per person. Do keep an eye out for further details on members’ discount and early bird rates – bookings will open on 8 August.

Please REGISTER YOUR INTEREST TODAY to guarantee your place: by email to [email protected] 

 

The Institute of Health Visiting (iHV) announces the launch of its International membership whilst Dr Cheryll Adams CBE, iHV executive director, Professor Dame Sarah Cowley, iHV Trustee, and Dr Karen Whitaker, iHV Fellow, attend a UNICEF meeting in Leiden, Holland, as professional advisors to support the introduction of home visiting services in other countries.

iHV International membership has been introduced for those living overseas who would like to have access to the latest evidence-based research, reports, briefings and other materials relevant to the work of the health visitor.  In addition, this new category of membership helps the iHV to raise international awareness of the important role of health visitors.

Dr Cheryll Adams CBE, executive director, iHV, said:

“I am pleased to open up our membership of the Institute of Health Visiting to those health professionals living outside of the UK who work with babies, children, families and communities.  Membership of the iHV provides access to our vast number of excellent evidence-based resources and information to improve outcomes for children and families and reduce health inequalities.”

The announcement of iHV’s International membership coincides with Cheryll, Sarah and Karen’s attendance and presentations at a UNICEF meeting, being held in Leiden, Holland, where UNICEF is supporting the introduction of a home visiting service based on health visiting into 25 countries across Eastern Europe and Central Asia.

Dr Adams added:

“I am delighted we are helping support UNICEF to introduce home visiting services into other countries. UNICEF is turning to England as a source of best practice on the central role that the health visitor plays in the lives of families due to our history and the level of experience and sophistication in our systems.  The UK health visiting service is seen as the gold standard service to emulate, with the iHV as the ‘go to place’ to support these countries.”

In 2014, the iHV hosted a meeting for UNICEF where child and family health experts from Eastern Europe and Central Asia visited England to learn about the vital role that health visitors play in health and wellbeing outcomes for children and their families in England – they heard presentations on policy, education, research, practice, health visiting frameworks and tools.

Dr Adams added:

“We’re very proud here at the Institute of Health Visiting to be working with UNICEF to help child and family experts of other countries to improve the health and development outcomes of young children and their families in their own countries.  Health visitors in the UK play a vital role in ensuring that every child gets the best possible start in life – and the iHV supports UK health visitors to do just that!  And now, with our International membership, the iHV will be helping other health professionals to achieve the same in their own countries.”

The Local Government Association (LGA) has produced a booklet, with some great case studies, to help local authorities to understand the role of health visitors in improving the outcomes for children and families in the early years.

Improving outcomes for children and families in the early years: a key role for health visiting services

LGA – Improving outcomes for children and families in the early years: a key role for health visiting services

These case studies demonstrate examples of innovation. But there have also been challenges. Concerns have been raised that in some areas health visitor posts are being cut as a consequence of the reductions to local government funding.

The cuts to local authority public health budgets make it more important than ever for health visitors and commissioners to work together to monitor and evaluate the impact of the service.

Please see great new editorial written by our Trustees, Professor Rosamund Bryar, Professor Dame Sarah Cowley, Professor Sally Kendall, together with our executive director, Dr Cheryll Adams, and Nigel Mathers from the Royal College of General Practitioners (RCGP) – just published in this month’s British Journal of General Practice, titled Health visiting in primary care in England: a crisis waiting to happen?