Read the latest guest paper “The role of the health visitor: where are we now?” by Alison Morton, iHV CEO, published in this month’s Paediatrics and Child Health Journal. The paper is written in the easy to access style of this popular journal and will be of interest to health practitioners from all backgrounds who work with babies, children and families and share our ambition to improve health and reduce inequalities.

The paper outlines the USP of the profession as the backbone of early years services and a vital safety-net for all families; it ends with our call to policymakers and the next government for investment in health visiting to ensure that all families are supported from preconception and through the ups and downs of their parenting journey during pregnancy and the first five years of their child’s life.

“Since its inception, health visiting has adapted over the years to respond to the greatest public health threats of the day. With many similarities to 2024, in the mid-19th century there were huge public health needs across society, with multiple initiatives set up to try and improve the health of the population. At that time, attention was focused on reducing the high rates of infant mortality driven by malnutrition and communicable diseases spread through poor sanitation and unsafe housing. Of these projects and home visiting initiatives, many failed or went out of fashion – but health visiting stood the test of time.

“Health visiting has been described as the backbone of early years services across the UK and the safety-net around all families. With child health deteriorating, more children falling behind with their development, growing concerns about invisible vulnerable children, widening inequalities and soaring costs of late intervention, there is a clear imperative to act. Health visitors provide an important part of the solution; however, the service is facing significant challenges. When sufficiently resourced, health visitors play a crucial role in ensuring that families get good, joined-up support – preventing, identifying and treating problems before they reach crisis point. The benefits of an effective health visiting service accrue to numerous government departments, contributing to a whole system response to address a multitude of policy priorities for babies, children and families across health, education and social care.”

To find out more about the role of the health visitor, watch our short film “Health visiting in your community”.

Don’t just take our word for it – listen to a wide range of other organisations and individuals speaking up about the importance of health visiting:

Watch the short film on health visiting by Her Royal Highness The Princess of Wales who said, “Families need support, like we’ve seen today, more than ever. And it’s so important that we recognise and celebrate this amazing role that health visitors play up and down the country.” (HRH The Princess of Wales, 2023).
Watch the film here.

Read Why Health Visitors Matter by the First 1001 Days Movement.

On Wednesday 25 January, Channel 5 national news broadcasted a health visiting feature based on the recent iHV State of Health Visiting in the UK report – this is now available to view on You Tube. The news story highlighted the positive difference that health visitors’ support makes to families, as well as the current challenges that the profession is facing to meet the scale of need. The news piece featured statistics from our survey including soaring rates of poverty, mental health problems and domestic abuse.

The iHV was delighted that Channel 5 news shone a spotlight on these issues and the wider impacts of poverty on families.  Bromley Healthcare kindly enabled on location filming with Channel 5, where Jess Davidson, health visitor was home visiting Meera and her family for their 6–8-week review.

Jess gave an exclusive interview where she explained how she ‘loves her job, but the challenges in health visiting are growing’. Jess provided examples of how the cost-of-living crisis and cuts in funding for health visitors are impacting on families.

Meera, who has 3 children under the age of four said she would have been lost without her health visitor’s help.

Alison Morton was also interviewed, and highlighted how worried health visitors are about the current situation, highlighting the impact of families’ stress on babies, children, and families.

The iHV would like to say a heartfelt thank you to Meera and her family for generously sharing their story about the difference that their health visitor, Jess, made to her family. We would also like to thank Bromley Healthcare for their support in raising the profile of health visiting – this news story would not have been possible without their help. In particular, we would like to say a ‘huge thank you’ to Jess Davidson (health visitor) for sharing her own experiences – you did health visitors proud!

 

 

The Institute of Health Visiting (iHV) publishes the findings from the largest UK survey of frontline health visitors working with families across the United Kingdom.

Our survey findings paint a bleak picture with health visitors seeing first-hand the realities that families with babies and young children in the UK are facing. Health visitors are reporting epidemic levels of poverty, with more parents struggling under the weight of the cost-of-living crisis that is forcing them to turn to food banks to feed their children.  Alongside this, more parents are living with mental health problems, domestic abuse and adversity, that pose risks to the health and wellbeing of babies and young children.

Health visitors are witnessing the impacts of stress associated with poverty on children’s safety, health and development. At the same time, there are insufficient health visitors to meet the scale of rising need. This is being felt most acutely in England, as health visitors are battling to deliver a service following a loss of almost 40% of health visitors since 2015.  Consequently, despite health visitors’ best efforts, many families are not receiving the support that they need, and this is being intensified by a lack of capacity in other health and social care services who are also experiencing extreme pressures.

Alison Morton, Executive Director at the Institute of Health Visiting, says,

“Through their universal reach, health visitors have a privileged and unique view into the lives of babies, young children and their parents/ carers across the UK. Health visitors’ experiences presented in this report provide an important ‘early warning signal’ of the most pressing threats and challenges to the health and wellbeing of our youngest citizens which are often hidden behind front doors and invisible to other services.

“The findings also paint a deteriorating picture of a health visiting workforce under immense pressure as practitioners struggle to meet the scale of rising need. Families are facing the brunt of these challenges with a widening postcode lottery of health visiting support across the UK.”

We publish at a time of ongoing uncertainty with political and economic instability, and ever-increasing health inequalities that will get worse if not addressed. The whole of the health and care system is also struggling to rebuild in the wake of the pandemic. As health visitors often work alone, or in small teams in families’ homes, their work is often hidden and it’s easy to overlook how important it is. The NHS backlogs regularly hit the headlines, but they are only one part of the legacy left by the pandemic on the healthcare system; less high-profile backlogs of care and unmet need in health visiting services have been overlooked within a ‘baby blind spot’ in national policy which will leave equally serious challenges for both mental and physical health for babies, children and families across the UK, now and in years to come.

Alison concludes:

“Because the first years of life are so important for lifelong health, wellbeing and success, ignoring this tsunami of unmet need being experienced by our youngest citizens risks undermining the life chances of so many children.

“It is not too late to change direction and pursue reforms, but the situation is serious. There is now unequivocal evidence that the current rate of health visitor workforce attrition, and insufficient training places to plug the forecasted gaps, is not sustainable and will jeopardise the delivery of all UK Governments’ child health programmes.

“In England, the Government categorised health visiting as one of six priority services in its Start for Life Vision for the first 1001 days. However, this commitment is at risk without investment and a plan to rebuild the health visitor workforce.”

Rising needs and widening inequalities – child safety, health and development: the problem, some key facts and stats:

  • 91% of health visitors reported an increase in poverty affecting families over the past 12 months
  • 91% reported an increase in families needing foodbanks
  • 83% reported an increase in perinatal mental illness
  • 75% reported an increase in domestic abuse.

Health visitors have witnessed first-hand the impact on babies and young children’s safety, health and development:

  • 84% of health visitors reported an increase in children with speech, language and communication delay
  • 76% an increase in child behaviour problems
  • 60% of health visitors reported further increases in child safeguarding over the last 12 months (building on significant increases reported last year).

Health visitors in England also raised serious concerns that national data mask increases in child safeguarding, as:

  • Children living with significant risk and vulnerability are not detected as services are cut, and
  • Social workers’ caseloads are capped to a maximum – growing numbers of children living with significant risk and vulnerability now fall below higher thresholds.

Only 7% of health visitors in the UK felt confident that all families would be able to access the support they needed when a problem was identified. 86% reported that there was not enough capacity in other services to pick up referrals for support/ treatment

Our main policy recommendations:

  1. Prioritise the first 1001 days of life – a shared cross-government ambition and strategy for the first 1001 days is needed to improve health outcomes and reduce inequalities for babies, young children and families. This needs to be prioritised by the Treasury and seen as the smartest of all investments in our nation’s future, rather than as a cost.
  2. A shift towards prevention and early intervention is needed to support all people to lead healthy and fulfilling lives by addressing the key public health priorities that pose the greatest threats to our nation’s health, thereby preventing debilitating and costly ill health in later life.
  3. Equity of access to support is needed for all babies, children and families across the UK and an end to the current postcode lottery.
  4. System’s thinking – the benefits of an effective health visiting service accrue to numerous government departments and across a person’s lifetime. Complex system’s principles need to be applied across all aspects of health and care delivery, including workforce planning, funding and the development of measures that capture health visitor’s input and impact across the system.
  5. Integrated clinical care pathways with significant ‘front-loaded’ investment in prevention and early intervention are needed across health visiting, school nursing, midwifery, social care, General Practice, and early years, to ensure:
  • All babies, children and families are supported to reduce inequalities in key priority areas
  • All children at risk of poor outcomes are identified early
  • A continuum of support for a continuum of need is provided to achieve shared goals for key public health priorities for babies, children and families.
  1. Strengthening the health visiting service requires a clear plan focused on the following three areas:
  • Funding – All areas need sufficient funding to deliver the full national specification for the health visiting service and preventative public health programme for children
  • Workforce – A demand-driven, well-resourced national workforce strategy is needed to increase the number of health visitors to address current and forecasted losses, and improve retention, job satisfaction and career progression for experienced staff
  • Quality – National government must do more to:
    • support local authorities with resources to provide health visiting services at a level that delivers everything that government and NICE guidance expects of them, and that families need
    • hold local authorities to account when services are not meeting national guidelines
    • support the ongoing research, development and sharing of evidence-driven models of best practice based on proportionate universalism.

We are very excited to officially launch our iHV Leadership Conference, ‘Translating Vision into Reality’, which is being held on Wednesday 7 December 2022 at Woburn House Conference Centre in London. We are also pleased to offer virtual conference tickets this year, in addition to face-to-face, providing flexible options.

Our annual leadership conference provides an established forum for leaders in the fields of health visiting and the early years to come together with leading experts, as we focus on ‘Translating Vision into Reality’. Our conference this year also marks the 10th Anniversary of the Institute of Health Visiting – a perfect occasion to celebrate the very best of health visiting and the vital part that it plays in improving health and reducing inequalities.

This conference always receives excellent feedback from delegates who report that they leave feeling re-energised and reconnected.

The conference will explore the biggest public health challenges facing families with babies and children in the UK, as well as the most recent policy and evidence to equip leaders to build and deliver services to improve health outcomes and reduce health inequalities.

Don’t miss our special early bird ticket rates, available until 1 November – book your place today!

BOOK NOW

“Together we will explore what more needs to be done to address deep-seated issues in the health and care system, how to maximise the role of health visiting through visible leadership and by building a strong, collective voice to drive forwards transformation and advocate for social justice.”

Alison Morton, Executive Director iHV and Conference Chair

Programme & Speakers

This year we are delighted to have a number of very eminent speakers lined up to address our delegates, we also hope to welcome the new Chief Public Health Nurse for England and leaders of the Scottish HV evaluation. Delegates at this year’s conference will also be the first to see the premiere of our short film on health visiting across the UK which is currently in development.

Featured speakers include:
  • Professor Sir Michael Marmot Director, The Institute of Health Equity (UCL Department of Epidemiology & Public Health): The Social Determinants of Health and Health Equity
  • Jeanelle de Gruchy Deputy Chief Medical Officer, Office for Health Improvement and Disparities (OHID): Addressing Inequalities
  • Wendy Nicholson Acting Chief Public Health Nurse & Head of WHO CC Collaborating Centre for Public Health Nursing , Office for Health Improvement and Disparities (OHID): Leading, driving and innovating practice through evidence and policy

How to book

  • If you are an iHV Associate member, SCPHN Student member or a retired member, ensure you have your membership number ready to use as a discount code to secure your iHV member discount rate and go to the online booking link below.
  • If you are an iHV member but you do not know your membership number, please email [email protected]
  • If you are not a member but would like to take advantage of our member rates, please join us today!
  • Click here to go to our online booking system

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