As well as supporting health visitors, one of the iHV’s most important roles is to influence policies that affect the health of babies, children and families.  We do this in a number of ways – by working with policymakers and politicians across the UK and by raising the profile of what health visitors do, and its importance in a modern healthcare system.

We are fortunate to live in a time when we have more evidence than any other generation on the importance of getting it right in the earliest years of life – alongside supporting every child to reach their full potential, investing in these formative years also makes sound economic sense.

It is now time for the future government to step up to the plate to make “giving every child the best start in life” a reality!

Alongside tackling the wider determinants of health, all families should expect modern health services during pregnancy, the postnatal period and the earliest years of life that are on a par with the best in the world. Currently, families with babies and young children face a postcode lottery of support, health inequalities are widening, more children are falling behind with their development and are being harmed by conditions that are entirely preventable. Families are calling for better care.

On 4 July, voters will be going to the polls to decide which party they will trust with the leadership of our country, with health as one of the key issues.

The iHV is calling for a significant increase in the number of health visitors in England with three clear asks of the next government:

Policy: All families should receive the full offer of health visiting support as set out in national policy in the Healthy Child Programme and Health Visiting Model for England.


  1. Funding: All areas need sufficient funding to deliver the full specification for the national health visiting model and Healthy Child Programme Schedule of Interventions. Long-term investment, with ring-fenced funding, will help services to plan and build world-class services, ending the uncertainty of short funding cycles.
  2. Workforce: The national long-term workforce plan to retain, train and reform the health visiting workforce needs to be delivered in full, alongside funding for substantive posts. Demand-driven workforce modelling is needed to ensure that the workforce plan enables sufficient capacity to deliver the Healthy Child Programme to all babies, children and families as intended – it is estimated that 5,000 more health visitors are needed to meet the scale of families’ needs and replace workforce losses since 2015.
  3. Governance: Update OHID 0-19 Commissioning guidance – providing greater clarity and system levers to ensure equity of health visiting provision throughout England and ending the current postcode lottery of support that families face during pregnancy, postnatally, and through the first five years of their child’s life.

Key Messages:

  • Children born in England have some of the worst child health outcomes compared to other similar nations, with widening health inequalities, growing concerns about invisible vulnerable children, and soaring costs of late intervention. Tackling this requires a whole system response, including action to address the wider determinants of health. Action is also needed at an individual and community level to prevent, identify and treat problems before they reach crisis point. Health visitors provide an important part of the solution. When sufficiently resourced, they provide a vital infrastructure of support for families with babies and young children – with benefits that accrue across the health, education and social care system.
  • There are currently no levers to ensure that national policy set out in the Healthy Child Programme and Health Visiting Model for England are delivered. Families face a postcode lottery of support, with health visiting services experiencing significant cuts and role drift from their core “health” functions across numerous clinical pathways during pregnancy, postnatally, and throughout the early years. The needs of babies, children and families do not vary that much between local authority areas to justify the current variation in health visiting services across England.
  • Health visiting is the only service that proactively and systematically reaches all families from pregnancy and through the first five years of a child’s life. This provides support for all families across a breadth of physical health and mental health needs (for babies, children and adults), child development, social needs and safeguarding, and a vital safety-net for the most vulnerable that is not provided by any other service.
  • Cuts to health visiting services are having knock-on consequences across the health, education and social care system (for example, falling immunisation rates, fragmented postnatal care, increase in A&E attendance for children 0-4 years, inequalities in obesity rates, poor school readiness and soaring costs of late intervention/ child protection). Through their specialist public health role, health visitors can prevent, identify and work with families to treat problems before they reach crisis point.

Charity collective, Best Beginnings, Home-Start UK and the Parent-Infant Foundation, publish a new report sharing families’ experiences of lockdown during pregnancy or with a baby.

Babies in Lockdown: listening to parents to build back better (2020), based on a survey of over 5000 families, highlights the chronic under resourcing of services for families, the inequalities in babies’ early experiences and its worsening forecast due to the COVID-19 pandemic. The report warns that many families with lower incomes, young parents and those from Black, Asian and minority ethnic communities, will have been hit hardest by the pandemic. The Babies in Lockdown Report shines a light on UK baby inequalities as charities call on Government to act now to avoid a “Post-COVID19 lottery”.

Dr Cheryll Adams CBE, Executive Director iHV, commented:

“The iHV welcomes this excellent report which lays bare just how challenging it has been for many parents during lockdown. It was distressing to read their stories and, in particular, how the most disadvantaged have felt the hardest impact of lockdown and lack of support. It is important that we listen to the voice of these parents and ensure that we are better prepared to meet the needs of young children and their families as the pandemic continues. We support the report title, we now need to build back better for infants and their families and this will include ensuring that all families receive support from the health visiting service during this crucial stage of their parenting journey”.

The report tells us that:

  • COVID-19 has affected parents, babies and the services that support them in diverse ways.
  • Families already at risk of poor outcomes have suffered the most.
  • Without action, the pandemic could cast a long shadow on the lives of some babies.

The Babies in Lockdown: listening to parents to build back better (2020) report makes three policy calls for the UK Government:

  • A one-off Baby Boost to enable local services to support families who have had a baby during or close to lockdown.
  • A new Parent-Infant Premium providing new funding for local commissioners, targeted at improving outcomes for the most vulnerable children.
  • Significant and sustained investment in core funding to support families from conception to age two and beyond, including in statutory services, charities and community groups.

The Institute of Health Visiting very much welcomes the new NHS Long Term plan, in particular the new focus on investment into community and preventative services, and the commitment ‘….to consider whether there is a stronger role for the NHS in commissioning sexual health services, health visitors, and school nurses, and what best future commissioning arrangements might therefore be.’ (see NHS Long Term Plan page 33, 2.4).

Dr Cheryll Adams CBE, Executive Director iHV, said:

“This can’t happen soon enough as we continue to see fragmentation of health visiting services and a loss of very experienced health visitors across the country. This has been accompanied by an inevitable impact on the quality of services that the profession can now provide for babies and their families, our most vulnerable members of society. We know that this is leading to increased use of GP and A&E services, an increase in the number of children needing safeguarding protection, and that far too many children are starting school without adequate communication as well as other delays in their development. All these cause much greater expenditure for the state than the cost of providing a robust health visiting service and it is very encouraging to see prevention recognised in the ‘Plan’.

“We hope that this statement is the first step towards providing proper protection for primary preventative services, such as health visiting and school nursing, into the future and beyond. A cycle of investment and disinvestment, as has happened over at least the last 25 years, must now become a thing of the past so that England can be proud of the support it offers young families. Furthermore, society will feel the benefit of this with babies suffering less mental illness, less heart disease and less cancer in their later lives. These are all things that are impacted by what can happen to babies during pregnancy and the first months of life such as poor nutrition and being exposed to a poor emotional environment.

“We also hope that pledges for maternity services, such as continuity of care, will also be invested in for those receiving health visiting services. No one wants to discuss their problems with a stranger – trusted professionals in the community, such as health visitors, can literally change lives when their help is sought.

“In addition, we are delighted by the significant attention which the plan gives to addressing health inequalities. This is something which health visitors and the Institute see as key to creating healthy communities, so it’s very encouraging to see it so well articulated in the ‘Plan’.

“Whilst the commissioning of health visiting services is being re-examined as recommended by the Institute in its 10 year plan (September 2018), we call for the strengthening of training commissions in 2019 as a visual demonstration of the commitment to the professional contribution of health visitors as laid out in the ‘Plan’. This would start to rebuild the profession to a place where its impact can be felt once again.”

The Institute of Health Visiting (iHV) welcomes the findings of the Royal College of Paediatrics and Child Health (RCPCH) landmark report into the State of Child Health which calls for Government to introduce a comprehensive, national, child health and wellbeing strategy, reverse cuts to public health, and tighten controls over smoking, the sale of alcohol and advertising of foods high in fat, salt and sugar.

According to the report, a lack of strategic national focus and persistence of a wide gap between rich and poor in the UK is damaging the health of the nation’s infants, children and young people. Compiled by child health experts, with input from children and young people themselves, the report provides clear recommendations to improve child health.

Dr Cheryll Adams CBE, executive director of the iHV, said:

“The Institute of Health Visiting welcomes the findings of the report and fully supports all its recommendations.  The snapshot of children’s health in the UK captured in this State of Child Health report is very worrying and upsetting.  As a nation, we can’t afford to not invest in our children as they are our future, yet recently their needs seem to have become invisible against the many competing demands being made on government and the NHS. We know so much today with respect to what can influence children’s outcomes across their life course, and in turn benefit the whole country. It’s time to act, to help ensure the best health outcomes for all UK children today, and in the future, by giving them the best start in life.  As an absolute priority and first step, the cuts to public health budgets must be stopped.”

The State of Child Health report brings together data for the first time on a comprehensive list of 25 measures of the health of UK children, ranging from specific conditions such as asthma, diabetes and epilepsy, risk factors for poor health such as obesity and a low rate of breastfeeding, to child deaths. The data provide an “across the board” snapshot of child health and wellbeing in the UK.

Nearly one in five children in the UK is living in poverty and inequality is blighting their lives, with those from the most deprived backgrounds experiencing much worse health compared with the most affluent. Despite some improvements in the health of UK children over the last decades, there is clear disparity with Europe and other developed countries, and major cause for concern.

Dr Adams added:

“We at the iHV will be working with the RCPCH to support their campaign to ensure child health becomes a key political priority, as only then will the prime minister’s aspirations for reducing inequalities become a reality.”

State of Child Health report:

Available on Thursday 26 January –