Alison Morton, Executive Director iHV, joined Lee Thomas at BBC Radio Stoke this morning on an item which is part of a series on the impact of the pandemic on parents – with today’s session on new parents and health visiting.

podcast for BBC Radio Stoke

 

 

 

 

 

 

Alison said:

“It is so sad to hear these stories from those parents who have been seriously let down by a system which is under enormous pressure. And also the health visitors who have worked really, really hard through the pandemic to support thousands and thousands of families, but it hasn’t been enough.”

Alison stated that there are two main drivers for this situation in England: 1) that need has increased; and 2) the capacity of the service to respond has been stretched to the limit – with parents bearing the brunt of this.

“As many of the parents stated,  a lot of the health visiting services shifted to non-face-to-face, using video and telephone, but it is not the same as seeing someone face-to-face. The root of this can be traced to the beginning of the pandemic when the Government categorised health visiting as a partial stop service – there was a failure to recognise the health visitor’s vital role and the support that it offers to parents;  just being alongside parents.”

She also said that the current ‘sticking plasters are not good enough’ and we need a national plan to put it right for children now.

The news item on parents and the pandemic starts at 1:09:13 into the programme with parents providing their experiences, and Alison joins at 1:11:41 with the item ending at 1:19:33

The Institute of Health Visiting (iHV) has published “Making History: health visiting during COVID-19”, a collection of case studies which presents a window into the working lives of health visitors and families navigating the ups and downs of the COVID-19 pandemic.

 

In these unprecedented times, the world “locked down”. Yet life continued, babies kept being born and the normal struggles of parenthood became amplified for many.

Whilst some families enjoyed the relative peace of an enforced slower pace of life; most families were negatively impacted by lockdown and home was not a safe place for some, with rates of domestic violence and abuse, mental health problems and safeguarding concerns quickly becoming a source of concern.

The case studies, family stories and creative pieces contained within “Making History: Health visiting during COVID-19” capture the pace and scale of change as health visiting services adapted to working during “lockdown”.

Alison Morton, Director of Policy at the Institute of Health Visiting, commented:

“It has taken a global public health pandemic to shine a spotlight on the importance of the health visiting service.

“Parents reached out to health visitors for support as many other sources of support were no longer available. Health visitors are Specialist Community Public Health Nurses providing a vital “safety net” for babies, young children and their families whose needs can easily be hidden from sight. Their specialist public health skills, supporting babies, young children and their families during the biggest public health emergency in living memory, have been needed more than ever.”

Health visitors have risen to this challenge with professionalism and autonomy, flexing and developing innovative service “workarounds” to ensure that families receive the best possible support. Different areas have responded in different ways, many introducing “virtual contacts” instead of face-to-face, as well as rapidly responding to urgent needs to support families using Personal Protective Equipment.

Councillor Ian Hudspeth, Chairman of the Local Government Association Community Wellbeing Board, commented:

“Councils are incredibly proud of how their public health workforce has responded over the last 6 months. This report is testimony to the commitment and resilience of health visitors and illustrates the pivotal role they play in ensuring children and families get the support they need in challenging times.

“In the upcoming Spending Review, we are asking the Government to reverse the £700 million of public health reductions, to enable councils to strengthen this workforce and ensure we can continue to support families when they need us most.”

Alison Morton concluded:

“We need to learn from COVID-19 and the experiences of families and health visitors to ensure that the health visiting service is strengthened and fit to face the challenges that lie ahead as we adapt to living with the virus for the foreseeable future. The challenges that we face are not insurmountable – individually and collectively we have the ability to put things right. But this requires bold action to make the difference – there is no time to waste, the time to act is now.”

 


Our recommendations for restoration of the health visiting service are:

  • Health visiting services should be reinstated (where they have not been) as a matter of urgency as a vital support and safety-net for children, with appropriate measures put in place, including the use of PPE, to reduce the spread of the virus.
  • Health visiting services must be fully prepared for any future waves of COVID-19. NHS England should revise the Community Prioritisation Plan (for phase one pandemic management) and develop clear messages on the importance of continuation of the service to ensure the needs of children are prioritised. This should include removing wording on the redeployment of health visitors.
  • A clear workforce plan is needed to ensure that the service has sufficient surge capacity to manage the backlog of missed appointments, as well as demand for support due to the secondary impacts of the pandemic.
  • An evaluation of the use of virtual, non-face-to-face service delivery methods is urgently needed to determine their effectiveness for identification of vulnerabilities and risks, impact on child and family outcomes and reducing inequalities to inform future digital change.
  • A cross-government strategy is needed to reduce inequalities and “level-up” our society – this will require investment to strengthen the health visiting service which plays a crucial role in the early identification and support of the most disadvantaged families.
  • The impact of working during the COVID-19 pandemic on staff wellbeing cannot be underestimated – a proactive plan is needed to ensure staff have the right support during the restoration of services and to create high quality workplaces for all staff in the future

According to a new survey from University College London (UCL), health visitors are concerned that the needs of children have been missed due to staff redeployment to support the COVID-19 workforce and increased caseloads.

The UCL survey of 663 health visitors in England, conducted between 19 June and 21 July 2020, found that 41% of respondents in teams that lost staff had between 6 and 50 team members redeployed between 19 March to 3 June 2020.

In approximately 10% of teams, which experienced a loss, this was a redeployment of at least half of their staff. Few teams (9% among those with staff redeployed) gained additional staff to fill the gaps. This meant that 253 respondents (38%) had their caseload increase, some with an increase of 50% or more, and 73% of those that experienced a change reported that their caseload had not returned to its usual size.

Dr Cheryll Adams CBE, Executive Director iHV, commented:

“The interim results of this research into the impact of redeployment of health visitors by University College London confirms all the anecdotal evidence already sent to the iHV by health visitors. Health visitors should never have been redeployed, instead their time should have been spent on reaching the most vulnerable families during lockdown and checking in on all other families. I don’t believe we yet fully know the impact of that period on children and families, but this research confirms that it was very significant for many families. Furthermore, there were significant impacts on the health visitors themselves, as those remaining strived to provide redesigned services and to reach the most vulnerable families, and those redeployed worried about the families they had left behind without opportunity for necessary handovers. I find the feedback on how the health of health visitors was impacted particularly distressing, this should not have been allowed to happen.

“Developmental reviews have now been delayed for more than four months and that too will mean that developmental delays are being missed and this could impact children for the rest of their lives. The already very diminished health visiting service in some areas of the country will be struggling to catch up whilst also juggling the challenge of maintaining their personal safety, and that of families. If we do face a second wave of COVID-19, health visitors must not be redeployed again. Instead, an urgent workforce plan is needed to rebuild numbers in the profession which are at their lowest for very many years and, alongside that, tackle the huge inequities in service delivery across England which have opened up over the past five years. It is not right that whilst children in some areas of the country continue to receive a reasonable service, children in many other areas now only receive a skeleton service, made even worse now by the challenges of service delivery during the COVID-19 pandemic.

“The first years of life lay down the foundations for our future health and wellbeing – get it right then and children will thrive and achieve at school and in the workplace; get it wrong, as we are now in England, and governments for many years to come will be paying for the consequences. The critical value of health visiting services is understood and invested in by the Scottish, Welsh and Northern Ireland governments. However, in England, it is not OK that an unwarranted variation of service quality has been allowed to open up as health visiting numbers continue to be allowed to plummet. I hope that the interim findings of this research will lead to prompt action. They have been published early as the researchers were so concerned by what they found.”

Dr Gabriella Conti, Associate Professor (UCL Economics and Institute of Fiscal Studies) who led the survey, said:

“Whilst all families are impacted by COVID-19, the most detrimental effects are felt by those who are already disadvantaged – in particular, our most vulnerable infants and children whose needs are often hidden from sight.

“Increased caseloads for a significant proportion of health visitors, along with reports of a lack of PPE for home visits, has created a lot of additional stress and anxiety, during a time of great uncertainty and difficulty.”

The researchers make a number of policy recommendations, including for:

  • Health visiting services to be reinstated (where not already happening) to provide vital support and a safety-net for children, with appropriate measures put in place, including the use of PPE, to reduce the spread of the virus.
  • An evaluation of the use of virtual, non face-to-face service delivery methods to determine their effectiveness for identification of vulnerabilities and risks, impact on child and family outcomes and reducing inequalities to inform future digital change.
  • A clear workforce plan to ensure that the health visiting service has sufficient capacity to manage the backlog of missed appointments, as well as demand for support due to the secondary impacts of the pandemic.
  • A proactive plan to ensure staff wellbeing during the restoration of services.

Research assistant Abigail Dow (UCL Economics) said:

“A cross-government strategy is needed to reduce inequalities and “level-up” our society. This will require investment to strengthen the health visiting service which plays a crucial role in the early identification and support of the most disadvantaged families.”

The survey, supported by the Institute of Health Visiting, was carried out using the online survey platform Qualtrics. Participants (98% female, 88% White British or Irish, and average age 50) were obtained with consent from the Institute of Health Visiting database. Data collection is still ongoing and a full report will be released later this year.

The Institute of Health Visiting (iHV) is delighted to announce the publication of a toolkit during #HVweek to support the measurement of outcomes in health visiting – it aims to support health visitor service leads in developing outcome measures for their local health visiting service.

There is a growing body of evidence which demonstrates that health visitors can have a positive outcome on health improvement (Cowley et al, 2013).

Health visitors are keen to show the impact of their work in early intervention, health promotion, and the prevention of ill health in children and families.  But how can this impact be measured?  What outcomes are needed?

Dr Cheryll Adams CBE., Executive Director, iHV, said:

“Since the completion of the Department of Health’s Health Visitor implementation plan ‘A Call to Action’ to transform health visiting services, there has been an increased emphasis on the need to measure the impact and effectiveness of the transformed health visiting services in England.”

Health visiting services collect data for key performance indicators as described in the National Health Visiting Core Service Specification (NHS England, 2014). These indicators mainly focus on the number of core contacts achieved, but this does not accurately reflect the depth and breadth of health visiting activity, nor does it describe the outcomes for children and families.

Dr Adams continued:

“There is now renewed pressure to demonstrate outcomes of health visiting services with the recent transfer from NHS to Local Authority Commissioning.  Local commissioners are developing their understanding of the health visitor role and how the service contributes to local and national public health outcomes, the local early years strategy and broader social, economic and fiscal outcomes.  Health visitors must therefore develop and gather information which is relevant to their practice and which captures the impact of health visiting interventions on health outcomes.”

This new toolkit, written by Ruth Hudson, Professional Officer, iHV, is broken down into six sections to explore both outcomes and evaluation in health visiting. The Practical Guide forms the introduction and background, followed by 5 sections for readers who may prefer to concentrate on a specific topic or aspect of evaluation:

  • Outcomes and Evaluation in Health Visiting: A Practical Guide
    1. Section 1: Research and Outcomes for Children and Families
    2. Section 2: Evaluation Guides and Models for use in practice
    3. Section 3: National Outcomes Frameworks, Tools and Resources
    4. Section 4: Outcomes in Health Visiting Practice
    5. Section 5: Presenting Information on Outcomes: Using Case Studies and Scale Measures in Practice