The iHV is delighted to have supported the launch of the new report on maternal mental health and the services that supported women and their families during the COVID-19 pandemic. We would like to put on record our thanks to the Alliance for undertaking this work and creating a public opportunity today for us to come together, to think together about the findings and their important implications for families now – need is great and families can’t wait.

 


Today’s report brings together, for the first time, all of the available data collected during the pandemic looking at the mental health challenges that women during and after pregnancy have faced. The evidence shows a significant increase in maternal mental health problems across the UK over the last 12 months

Speaking at the launch event today, iHV Mental Health Lead, Melita Walker highlighted the important role that health visitors play in identifying and supporting families experiencing mental health challenges, saying:

“Health visitors are qualified nurses or midwives who go on to study at a specialist level in public health to become health visitors. Every family has a health visitor, and they are there to support all members of the family to enjoy good health. Health is affected by a multitude of things so health visitors may be working with families to support a very broad range of need, and those needs, left unsupported as this report shows, can actually tip families into experiencing mental health problems. Health visitors have a vital role in promoting good mental health, preventing mental health problems, identifying them early, offering evidence-based interventions and care coordination when more specialist services are needed. Family mental health and wellbeing is “the bread and butter” of health visiting.

The perinatal period is a vulnerable time for the acute onset and recurrence of mental disorders. When these vulnerabilities are combined with the impact of a pandemic, mental health problems and health inequalities are affected further. We have seen parents struggling with isolation, and sadly, we are seeing an increase in, domestic abuse, child poverty, substance misuse and child maltreatment. Rates of mental health problems are increased and inequalities are widening.  The impact of lockdown has been unevenly distributed and families with lower incomes, from Black, Asian and minority ethnic communities and young parents are experiencing the most detrimental consequences due to compounding factors like overcrowded housing with lack of outdoor space, the effects of poverty, which all have an impact on parental stress, anxiety and predisposition to mental illness. The family centred holistic role of the health visitor cuts across and can make a difference in all of these areas- thus positively and proactively supporting good family mental health alongside a range of other health outcomes.

That said, health visitors can only make a difference if we have sufficient numbers of them and this report highlights that health visitors in England went into the pandemic in a hugely depleted state due to years of cuts to the health visiting service. The first two years of a child’s life are important, and the right support and guidance for families at this time can make a big difference to their long-term outcomes. HVs can be a lifeline for families and the iHV ‘s position from very early on in this pandemic was that there was “more than one frontline” and sustaining support for families’ needed to be a priority and that health visitors should not be redeployed.

It is important to note that many local authorities in England did not redeploy their health visitors, but 65% redeployed at least one health visitor and redeployment ranged from no health visitors being redeployed in some areas, to 63%, of the HV team being redeployed. Over 11% of local authorities lost over a quarter of their HVs. So, we can see, with redeployment rates differing substantially, young children and families’ access to health visiting services was determined by their postcode.

The iHV campaigned vigorously from the outset about redeployment and we were very relieved when England’s chief nursing officer Ruth May , Public Health England & the Local Government Authority sent a letter to all the CNOs stating that HVs provide ‘frontline’ work and should not be redeployed.

The learning we have now, and the swell of collective voices, hopefully means that we can be confident going forward in this and any future pandemic, that health visitors will remain on their own frontline. We are also very optimistic that the Leadsom review will contain some significant measures to strengthen the HV offer for families.

There has been a lot of learning from and throughout this pandemic and we must pay tribute to all the health visitors who continue to work really hard in some very challenging circumstances to find ways to stay alongside families to make sure they receive the care and support they need for their mental health. We have heard of some fantastic examples of health visitors turning to new ways of working and to get all of this up and running in the speed that they have is commendable.

Health visitors are telling us that virtual and digital help has allowed them to reach parents in the absence of being able to visit, and there may well be some of the virtual offers kept after restrictions have eased. They are also telling us very firmly, as is the emerging evidence included in this report, that virtual should not replace face to face contacts.

The research is showing us that there are significant increased MH problems in parents who have experienced becoming a parent during the pandemic. If we are to meet this need then all services need to work together as a system, and all parts of that system need to be strong.

We know a robust home visiting – health visiting service works- we need to build back our health visitor numbers because as this report shows, health visitors are a critical part of the solution for achieving good family mental health and wellbeing”.

iHV welcomes the NSPCC ‘Fight for a Fair Start’ campaign – calling on Government to ensure all new parents receive a minimum of five face-to-face visits from the same health visitor.

Dr Cheryll Adams CBE, Executive Director iHV, commented:

The Institute of Health Visiting welcomes the NSPCC Fight for a Fair Start campaign and its call to strengthen the essential support that health visitors should be offering to all families during the first years of their baby’s life.

The reduction in universal contacts by health visitors following the loss of one in four health visitors over the past 4 years, often accompanied by fragmenting of continuity of care, means that there may be a generation of children and new families with emotional health needs which are going unrecognised. Indeed, the Children’s Commissioner has already expressed her concern regarding hidden children, those with significant needs who may not be sufficiently well known to services. We are aware that the number of referrals to child mental health services has doubled over the past few years and this can only be set to increase further unless there is new investment into supporting new families.

Implementation of the new green paper on public health (Advancing our health: prevention in the 2020s) would seem to provide an impetus for reinvestment. We hope that the Treasury will take that opportunity using the next Spending Review before even more children’s lives are affected.

One in four families across England are missing out on vital health visits as their baby reaches their first birthday, increasing the risk of mental health issues with the parents going undetected. Data from Public Health England for 2017/18 has also revealed that these 12 month visits drop to around one in two for families living in London.

In addition, further NSPCC research highlights that antenatal visits are particularly inconsistent, with an estimated 38% of families not receiving a health visit before the mother gives birth.

The transfer of budgetary responsibility for health visiting services from the NHS to local authority public health in 2015 has coincided with a significant reduction in the public health budget and workforce numbers.

There has been a 26% fall in health visitors employed by the NHS operating nationwide between 2015 and 2019, with almost half of those still in the service working with caseloads of more than 400 children each. The Institute of Health Visiting recommends a maximum of one health visitor to every 250 children to ensure a safe service is delivered.

In response the NSPCC is launching a national campaign Fight for a Fair Start’, and is calling on the Government to ensure all parents receive a minimum of five face-to-face visits undertaken by a consistent health visitor.

The NSPCC is inviting people to join the campaign by raising their voice and signing the Fight for a Fair Start petition.

 

NHS Business Services Authority is working with on a Department of Health & Social Care project to improve the Healthy Start scheme and is looking for some health visitors to interview about their role and experience.

Healthy Start provides vouchers for pregnant women, children, parents and families in receipt of qualifying benefits to buy fruit, veg, milk and vitamins. The scheme currently uses paper-based vouchers, however they intend to trial the use of prepaid cards and an online application process.

An important part of this project involves talking to healthcare professionals that help promote the scheme – so they are looking for some health visitors to interview. To do this they conduct telephone calls, which last around 30mins. The call is carried out by their researchers, it’s an informal chat to find out more about your role and your experience of promoting the Healthy Start scheme.

They are looking to do the research calls next week between  Monday 24 and Thursday 27 June. They are flexible on the day and times.

If you are able to help by taking part, simply email [email protected] with the details below:

  • Your availability (give day and preferred times)
  • Your role
  • How long you have been in your role?
  • Do you currently promote Healthy Start with the families you see?

The Institute of Health Visiting (iHV), alongside 5 health organisations, is delighted to publish the new Recommended National Curriculum for Specialist Community Public Health Nursing – Health Visiting/School Nursing (0-19 child public health nursing services).

The Recommended National Curriculum is a consensus statement of the overarching knowledge, skills and attributes that can be expected of Specialist Community Public Health Nurses delivering health visiting and school nursing services to families, children and young people from age 0-19.  It is the product of a consensus-building partnership between the Institute of Health Visiting (iHV), Unite/Community Practitioner Health Visitor Association (CPHVA), United Kingdom Standing Conference (UKSC), National Forum of School Health Educators (NFSHE), School and Public Health Nurses Association (SAPHNA) and the Royal College of Nursing (RCN).

Recommended National Curriculum

Developed for use by curriculum developers and providers of health visitor education including higher education institutes, private providers, charities and other voluntary sector organisations, amongst many others, the Curriculum provides authoritative evidence-based guidance applicable across the whole UK in the context of rapid change in policy and practice, fragmentation of services and inconsistency in delivery.

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

“Parents, children and young people consistently highly rank having good access to a health visitor or school nurse as being important as a source of advice and support due to their reliable knowledge and expertise on the health issues that matter to them.  The publication of this Recommended National Curriculum provides a consensus statement of the overarching knowledge, skills and attributes for nurses to be educated and trained to deliver this specialist level of community public health nursing across the UK. The partners collaborating in the development of this curriculum commend its use to commissioners and providers of health visiting and school nursing education and services, and to the NMC as it reviews its Standards of Proficiency.”

The Recommended National Curriculum provides a firm basis for future developments in individual higher education institutions and also at a national level, when the Nursing and Midwifery Council (NMC) proceeds with its Programme of Change for Education and reviews the Standards for Specialist Community Public Health Nursing.

The curriculum also endorses health visiting and school nursing as a distinctive level and form of practice that warrants regulation, to assure the public of the professional standards that they can expect of registrants prepared for and practising as health visitors and school nurses.

iHV is a signatory to a letter, lead by the Royal College for Paediatric and Child Health (RCPCH), which was sent to the Health Service Journal (HSJ) in response to an article written last week about how public health cuts are damaging to child health.

The HSJ investigation revealed that services aimed at children and young people are bearing the brunt of cuts to public health spending by local authorities.

Overall, their analysis identified planned spending reductions worth £50.5m in 2016-17, across 77 local authorities which provided information. Of the £50.5m cuts in 2016-17, the biggest single area was a £7m reduction to services directly aimed at improving the health of children and young people, such as health visiting, school nursing and childhood obesity programmes. These represented 14% of the total.

The letter signed by 12 leading specialists, warned that any spending cuts imposed by local authorities could have a “significant impact on the future health of children”. Scaling back spending on health visitors, child obesity programmes and school nurses will have a detrimental effect on the future health of children and young people in the UK it said.

A copy of an article in relation to this can be found on the HSJ and you can see a copy of the letter in full on the RCPCH’s website.

The letter is also shared below:

Dear Sir,

At a time where child wellbeing in the UK ranks a poor 16th out of 29 income rich countries, putting us below Slovenia and the Czech Republic, children are becoming overweight or obese earlier and breastfeeding rates are deemed the worst in the world, it is highly concerning to learn that of the £50.5m spending reductions planned for 2016-17 by local authorities, the biggest single area affected was services directly aimed at improving the health of children and young people (‘Children’s services hardest hit by public health cuts,’ 4 July 2016). Cuts are also affecting services for pregnant women such as smoking cessation and this could have a significant impact on the future health of children.

If we are to improve outcomes for children and young people in the UK, then it is vital that services provided by local authorities such as health visiting, school nurses and weight management programmes are protected. Without them, obesity rates will rise and the associated health costs will spiral, breastfeeding rates will fail to get better and thousands of babies each year will miss out on the many benefits it provides. In addition, obesity prevention, school nurses and health visitors are all important in the prevention and early detection of mental health problems, so these services are vital for maintaining both the physical and mental health of our children. We call on Government to invest in child health now because by doing so, it will protect the future health of the nation.

Professor Russell Viner, Officer for Health Promotion, Royal College of Paediatrics and Child Health (RCPCH)
Shirley Cramer, CEO, The Royal Society for Public Health (RSPH)
Professor John Middleton, President of the Faculty of Public Health
Sarah Carpenter, head of Health, Community Practitioners’ & Health Visitors’ Association
Sarah Carpenter, head of Health, Unite
Dr Ingrid Wolfe, Chair, British Association for Child & Adolescent Public Health
Janet Davies, Chief Executive & General Secretary at the Royal College of Nursing
Dr David Richmond, President, Royal College of Obstetricians and Gynaecologists (RCOG)
Dr Cheryll Adams, CBE, Executive Director, Institute of Health Visiting
Cathy Warwick, CEO, Royal College of Midwives
Jane Barlow, President, Association of Infant Mental Health
Stephen Dalton, Chief Executive, NHS Confederation
Bernadka Dubicka, Vice-chair, faculty of child and adolescent psychiatry, Royal College of Psychiatrist, Honorary reader, University of Manchester; Consultant psychiatrist, Lancashire Care Foundation Trust
Prof Karen Middleton, chief executive of the Chartered Society of Physiotherapy