Delay to Public Health Grant will cause ‘avoidable and unacceptable’ harm

With just one month to go before the new financial year, the Institute of Health Visiting has joined over 30 leaders of public health, NHS bodies and health charities calling on the Government to urgently publish next year’s Public Health Grant allocation.

The coalition, led by the Association of Directors of Public Health (ADPH), the NHS Confederation, the Local Government Association (LGA), the Faculty of Public Health (FPH) and the Royal Society for Public Health (RSPH), is also urging ministers to increase investment in public health and prevention – a strategy which, although known to have a long-term benefits to individuals, communities, the NHS and wider economy, has been repeatedly overlooked in recent years.

In a joint statement published today, leaders across the sector have outlined their concerns to the Government:

The Government’s delay in publishing the Public Health Grant allocation for 2023/24 is putting public health services at risk and adding unnecessary strain on an already pressured system.

In addition to not yet knowing what the public health budget will look like for the coming year, we are extremely concerned that the delay will be exacerbated by either only a small increase or another flat cash settlement.

Despite several important Government strategies being sidelined or delayed – including the updated Healthy Child Programme – there have been a series of promising announcements giving a commitment to public health initiatives. However, these initiatives are not being adequately – or consistently – funded. In particular, the Best Start in Life strategy fails to meet the scale of rising need and does not address the workforce shortages in health visiting.

Instead, funding has been cut in real terms by almost a quarter since 2015. While the current investment is of course welcomed, anything less than inflation is in effect a cut and, as a result, it is impossible for providers to keep up either with policy ambitions or the growing demand on these vital public health services. We simply cannot keep delivering more for less.

Without investing in evidence-based measures that are proven to prevent and reduce physical and mental ill health, demand on the NHS will continue to rise, sickness in the workforce will continue to increase and the economy will continue to suffer as a result.

Greg Fell, ADPH Vice President said:

“We can’t plan high quality, value for money, services without knowing how much money there is to spend on them. Individuals, their families – and therefore their communities – will undoubtedly suffer purely as a result of this delay”.

You can support the cross sector call on Government to urgently publish the Public Health Grant allocation by sharing the link to the coalition statement on social media.

Casting Long Shadows Report

The ongoing impact of the COVID-19 pandemic on babies, their families and the services that support them.

A brand-new report by the First 1001 Days Movement and the Institute of Health Visiting has been published today – ‘Casting Long Shadows: The ongoing impact of the COVID-19 pandemic on babies, their families and the services that support them.’

The report reveals worrying new statistics about babies and young children born or growing up through the COVID-19 pandemic, highlighting how more young children are at risk of harm, have delayed social skills, and have been affected by poor parental mental health.

The report findings were synthesised from evidence in recently published reports, research and national data, as well as analysis from a national survey of 555 professionals and volunteers who work with babies and their families in health visiting, mental health, maternity, early education, and other services.

The findings are compelling and are consistent with a whole raft of studies from multiple sources across the children’s sector, which all indicate that the wide-reaching impacts of the pandemic are far from over for our youngest members of society:

An alarming 94.8% of professionals say the pandemic has an ongoing negative or very negative impact on the personal and social skills of children who were living in the pandemic. 92.4% of professionals say the same for communication, speech, and language skills and for emotional wellbeing and development.
Almost half (42.7%) of respondents surveyed stated that “many” babies they work with are affected by parental anxiety, stress, or depression due to the pandemic, which is affecting bonding and responsive care.
More than 4 in 10 (44.1%) of respondents said that “many” of the babies they work with are currently affected by increased exposure to domestic conflict, child abuse and neglect.
4 in 10 (40.4%) survey respondents reported “many” babies they worked with had been affected by the loss of family income or increased risk of food poverty.

The report also highlights how:

Services have not returned to normal, and this could impact future generations – Whilst there has been innovation in service provision, nearly 6 in 10 respondents (59.5%) who reported that their service was operating differently, told us that the changes were not beneficial for families.
Services are in ‘crisis’ – The pandemic exacerbated existing strains on services. A significant number of survey respondents raised issues relating to low staffing numbers and poor staff wellbeing, with some professionals talking about services being in “crisis”.
The majority of respondents (90.5% in England) did not feel that national or local governments had taken sufficient action to ensure that babies under two and their families receive the support they need to recover from the impact of the pandemic.

With so much compelling evidence, The First 1001 Days Movement and Institute of Health Visiting are calling for:

National Government to take concerted action to address the impacts of the pandemic on our youngest children.
Integrated local strategies are needed to ensure that all children have the best start in life.
National Governments must have long-term child health and development strategies, supported by workforce plans.
Clear leadership within the UK Government is needed to ensure policy decisions include a cross-government focus on the needs of babies and young children. To ensure that this does not fall in the gaps between departments, a cabinet member should be appointed to drive this forward and act now to mitigate the impacts of the pandemic on our youngest citizens.

Alison Morton, iHV Executive Director, said:

“This report helpfully pulls together the unequivocal evidence that the pandemic’s impacts on our babies and young children have been significant and demand much greater attention from policy makers. What happens during these critical earliest years of life really does matter as they lay the foundations for future health and wellbeing. Yet, the report paints a bleak picture for babies in the UK. Too many are missing out on vital early support that can make such a difference. Ignoring this growing problem of unmet need and avoidable harms is short-sighted and will prove more costly in the long run.”

Georgina Mayes, Policy and Quality Lead at the Institute of Health Visiting, said:

“This new report clearly shows that the pandemic is having a lasting impact on many children’s health, wellbeing and development, and on the ability of services to meet their needs. More children are falling behind, inequalities are widening, and some services are reaching a crisis point. Whilst many professionals are working hard to support the families that they work with, this report clearly shows that demand is outstripping the workforce’s capacity to meet the scale of need.

“We call on national and local governments across the UK to take the findings of this research seriously and act now to mitigate the impact of the pandemic on our youngest children’s lives and life chances.”

Read the full report here

iHV speaks about health visiting on BBC Radio Stoke

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.

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

Go to BBC Radio Stoke programme

Spotlighting the vital “safety net” that health visitors have provided for babies and young children during the current pandemic

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.”

Read iHV's Making History: health visiting during COVID-19

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

iHV comments on UCL survey on impacts of COVID-19 on Health Visiting in England

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.

Download The impacts of COVID-19 on Health Visiting in England - first results

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.

New toolkit for measuring outcomes and impact in health visiting practice

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

Download the practical guide introduction

To access Outcomes Toolkit Sections 1-5