Today, the House of Lords Primary and Community Care Committee published its report ‘Patients at the centre: integrating primary and community care’, in response to the consultation it held earlier this year.

The consultation explored the many challenges facing primary and community care and the sustainability of the NHS. These include high service demand, an ageing population, workforce shortages and insufficient preventative care. The Committee explored how integrating services could address these challenges and sought evidence from clinicians, community care services, local authorities, researchers and voluntary organisations from across the country.

The Institute of Health Visiting was asked to contribute to the consultation and we did this in a number of ways:

  • Alison Morton, iHV CEO, submitted written evidence in April 2023.
  • Professor Sally Kendall MBE, who is one of the iHV’s four founding health visitors and an Honorary Fellow, presented oral evidence as a witness.
  • Sarah Cartner, a member of the iHV’s Health Visitor Advisor Forum, and a health visitor from Newcastle Upon Tyne Hospitals NHS Foundation Trust, also represented the iHV at a roundtable event hosted by the Committee at the Palace of Westminster – read her Voices blog.

We were delighted to see that health visiting has been recognised as a key sector of the health service, within  the report. The report also highlights the challenges of workforce shortages and fragmented models of care, alongside the hugely valuable service that health visiting provides to GPs and families. Evidence from Professor Campbell, Professor of General Practice and Primary Care at the University of Exeter is cited. He states, “Health visiting … has been hugely valued by GPs and their teams, but it is now no longer really part of general practice. Sadly, we have lost so many health visitors that we do not know who these people are or where they are. They provide a hugely valuable service, safeguarding and supporting families and people with long-term conditions.”

Alison Morton, iHV CEO, commented:

“We are delighted to see that health visiting has been recognised as a key sector of the health service by the Committee. The report also highlights the very real challenges of workforce shortages and fragmented models of care that are having a significant impact across the whole health and care system.

“In his evidence, Professor Campbell, Professor of General Practice and Primary Care, speaks for many GPs, highlighting how much they value health visitors and the work that they do to safeguard and support all families. He also raises valid concerns about the impacts of the depletion of the health visiting service in recent years which is hampering collaborative working. Close working relationships between health visitors and GPs are vitally important to support their collective work with all babies, young children and families, and particularly those living with complex conditions, risk and vulnerability. We share the Professor’s concerns and support the recommendations in this report. To deliver better joined-up care, we urgently need more health visitors.”

The Integration of Primary and Community Care Committee Report’s has 4 key recommendations:

  1. Structures and organisation of NHS services need to be streamlined. Integrated Care Systems (ICSs) are a good starting point for collaborative working but their relationship with other healthcare bodies, public bodies, and local government must be based on mutual professional respect. The Department of Health and Social Care (DHSC) should evaluate ICS structures before implementing any major health service reforms.
  1. There needs to be a more simplified and flexible system for awarding contracts and allocating funds within the NHS to encourage multi-disciplinary, integrated working. DHSC and NHS England (NHSE) should reform the contract process and ensure new contracts are flexible in the commissioning of primary care. The Government should explore different ownership models for GP practices to facilitate more joined-up and better care.
  1. Efficient data-sharing is crucial to successful healthcare integration. Fragmented systems often require patients to repeatedly provide the same medical information, causing frustration. A properly maintained Single Patient Record (SPR) and the ability for intersectoral data-sharing between healthcare professionals are essential to tackle this issue. The DHSC must issue guidance to standardise data practices and clarify data sharing within privacy laws, to ensure timely patient access to medical data.
  1. Equipping staff to work across multiple clinical disciplines through improved training will make integration of services easier. Currently, staff spend more time meeting everyday demand, rather than implementing new integration strategies. Clinicians should be introduced to the work of other services through job rotations. Social care needs should also be included in the NHS’s Long Term Workforce Plan to ensure that enough well-trained social carers are available.
Sally Kendall MBE, Professor of Community Nursing and Public Health at University of Kent, said:

“Despite some strong evidence to the Committee in relation to integration across all community services, it is disappointing that children’s health does not receive a lot of specific attention in the report. Childhood is lived in the home (wherever that may be), school, nursery and neighbourhood. There is a huge opportunity for ICBs to come together with local authorities and the NHS and voluntary sector to integrate health for all children and close the inequality gap. This opportunity may be lost for future generations of children if ICBs do not recognise the importance of the community services such as health visiting and school nursing and their navigational role with primary care and other community services to ensure that children’s health and safeguarding needs are met.”

Links for further reading:


iHV responds to the House of Lords’ Public Services Select Committee report published today into how public services support children and families – Children in crisis: the role of public services in overcoming child vulnerability.

Baroness Armstrong of Hill, Chair of the Select Committee, reports:

“We found a crisis in child vulnerability. Over a million children are now growing up with reduced life chances, too many ending up in care, too many with poor health outcomes… The crisis has grown worse during the pandemic, but it’s been building for many years, partly due to large cuts in early intervention funding.”

This important report is a stark reminder that underinvestment has created worse outcomes for children and higher costs for the taxpayer, as children slip through the gaps between services and do not get the support they need. The report includes clear recommendations for a national strategy for child vulnerability, and also recommends that ‘health visiting’ should be key partners in delivering Family Hub provision.

Responding to the report, Alison Morton, iHV Executive Director, said:

“Today’s hard hitting ‘Children in Crisis’ report lays bare the preventable suffering and misery that has been caused to our nation’s children whose needs have been largely overlooked.

“Cuts have consequences and the poorest children have been hit the hardest. It is time for the Government to prioritise children in their plans to ‘Build Back Better’, particularly babies and young children who have been overlooked the most.

“We call on the Government to make good their pledge to ‘rebuild health visiting’. Health visitors provide a vital infrastructure of support for all families, and a crucial safety-net, identifying vulnerable babies and young children.

“The Government say that they will maintain the Public Health Grant, but this is being maintained at a level that is too low to fund the number of health visitors needed to support all families and identify vulnerable babies and young children. Following years of cuts since 2015, there is now a national shortage of 5,000 health visitors in England and the profession faces its biggest workforce challenge in living memory. As a result, despite health visitors’ best efforts, the service is now so stretched that many families are not getting the support they need, and vulnerable babies and young children are being let down.

“Investment in health visiting is needed to provide the prevention and early intervention support to stop this growing tsunami of children in crisis. This cannot wait any longer – our nation’s children deserve better.”

In the House of Lords Questions on 20 January, Baroness Watkins of Tavistock and Baroness Walmsley highlighted the importance of a properly resourced health visiting service for parents and young children, particularly the most vulnerable families, post Covid.  They called for assurance from the Government that there will be additional resources for the health visitor workforce, in particular to help them to catch up with missed visits to vulnerable young families during the pandemic.

Baroness Watkins also challenged the Minister (Baroness Berridge, Parliamentary Under-Secretary (Department for International Trade) (Minister for Women)) to rigorously evaluate the effectiveness of video contacts with parents before their widespread adoption. Her question asked:

‘My Lords, health visiting has continued during lockdown, using video contacts with parents instead of face-to-face visits. Can the Minister assure the House that this approach will be rigorously evaluated before widespread adoption? This is particularly important given the recent stark findings from the child safeguarding practice review, which showed that the number of children dying or being seriously harmed after suspected abuse or neglect rose by a quarter, to 285 notifications, during April to September in England. Of these, 102 involved babies under the age of one. Does the Minister agree that it is vital that a properly resourced health visiting service is available to parents and young children, particularly the most vulnerable families, post Covid?

Acting Executive Director Alison Morton said:

“It is enormously helpful that Baroness Watkins of Tavistock and Baroness Walmsley have highlighted the impact of a reduced health visiting workforce, alongside the lack of evidence and potential unintended consequences of video contacts on child safety.  We hope that the Minister will be able to provide reassurance that the questions raised in Wednesday’s debate will be taken seriously.”