iHV calls for more health visitors in Spending Review submission

Yesterday, the iHV submitted its policy proposals to the government’s Spending Review making the case for rebuilding health visiting services in England. The Spending Review provides an important opportunity for professional bodies to influence government spending over the next three years. The government has stated that they will use the Spending Review to change the way public services are delivered by embedding a mission-led approach, driving forward public service reform and making the best use of technology to better deliver services.

Our response brings together the collective voice of health visitors captured in our annual survey and the wider work of the Institute, outlining the poor state of child health and rising levels of need experienced by babies, children and families that cannot be ignored any longer. We are delighted that our call for investment in health visiting has attracted widespread support from across the child health and early years sector – the message is clear, we need more health visitors!

To improve our nation’s health and reduce pressure on NHS services, much greater attention needs to be given to prevention, early identification of health needs, and early intervention in the critical earliest years of life. Health visitors have a vital role to play as part of the “health” workforce, contributing to multiple clinical pathways through pregnancy, the perinatal period, and 0-5 years (for babies, children and adults).

It is therefore vital that the “broken” state of health visiting is addressed, alongside the NHS, with action to reverse the loss of more than 40% of health visitors since 2015. The cuts to health visiting services have been a false economy, impacting on families’ quality of healthcare and placing additional burdens and costs on other parts of the healthcare system.

Our request aligns with the government’s objectives to prevent ill-health by improving child health, and reform health visiting to reduce spiralling costs of late intervention. Our brief summary sets out our policy proposal:

To address the loss of more than 40% of health visitors (HVs) since 2015 and ensure all families receive support in line with the Healthy Child Programme, ring-fenced funding is needed for 1,000 extra HV posts each year for the next 3 years.
To reform health visitor services and support workforce retention, salary uplift funding is needed for 689 specialist HV posts (providing clinical leadership for government priorities, like perinatal mental health, immunisations and SEND).

Benefits and policy rationale

More health visitors are needed to deliver the government’s ambitions for prevention and early intervention (across health, education and social care), including reducing children’s A&E attendance and improving immunisation uptake, the quality of postnatal care, and early identification and support for “school readiness” and SEND.

Deliverability of proposals: It is far easier to rebuild and reform a tried and tested service like health visiting than invent a new preventative health workforce, with all the regulatory and training infrastructure needed for quality assurance and to protect the public. We welcome the government’s commitment to “reform health visiting”. This will require actions to improve workforce capacity, recruitment and retention.

Costs:

Costs of 1,000 more health visitor posts are £52.9m for year 1, £105.8m for year 2, and £158.7m for year 3.
Salary uplift costs for 689 specialist HV posts are £8.64m per annum (from band 6 to band 7).

We submitted our brief policy summary online on 10 September, alongside our supporting information and costings – available here.

Government announces 75 Local Areas eligible for Family Hubs’ investment

The Institute of Health Visiting welcomes Saturday’s announcement by the Government of the 75 local authority areas selected for a share of £302 million to create new Family Hubs in England.

The announcement puts an end to an anxious wait for local authorities, and was made as part of a broader package of family-related announcements, including announcements relating to the Supporting Families programme and the government’s holiday activities and food programme. The full press release can be found here; it includes the names of the 75 eligible local authorities. The methodology for pre-selecting the 75 local authorities eligible for the programme can also be found here.

The Family Hubs and Start for Life programme is jointly overseen by the Department of Health and Social Care and the Department for Education. The Best Start for Life Vision to give every child the best start in life was launched last March, and the funding settlement was first set out in the autumn budget.

The £302 million for the Family Hubs and Start for Life programme includes:

£100 million for bespoke parent-infant relationship and perinatal mental health support
£82 million to create a network of Family Hubs, improving access to a wide range of integrated support services for families with children aged 0-19
£50 million to establish breastfeeding support services
£50 million to fund evidence-based parenting programmes
£10 million to support local authorities to publish a clear ‘Start for Life offer,’ and
A further £10 million to to trial innovative start for life workforce models.

Importantly, the Government has stipulated that the health visiting service is central to the success of the Best Start for Life Vision and is listed as one of six essential services that will form the core of the infrastructure of support available to all families in the Family Hub model.

Whilst no specific ‘ring-fenced’ investment in health visiting was forthcoming in this announcement, we have been advised by Government Advisor and Chair of the Early Years Review, Dame Andrea Leadsom MP, that health visitors will be ideally placed to make the most of this investment and deliver increased packages of support to address the priorities of breastfeeding, parent-infant relationship and perinatal mental health support and evidence-based parenting programmes as part of an integrated system of support. Within the 75 local authority areas, 5 areas will also receive a share of £10 million to trial innovative start for life workforce models to strengthen health visiting support.

Alison Morton, iHV Executive Director commented:

“This announcement will be good news for 75 local authorities who will receive much needed investment to strengthen the support that they provide to babies, young, children and families during the critical first 1001 days of life which lay the foundation for future health, wellbeing and success across the life course.

“To achieve their ambition to tackle health disparities and level up, it is vital that the Government also invests in the universal health visiting service which is a preventative public health service that ‘goes upstream’ and reaches all families – ideally preventing problems happening in the first place or identifying them early.

“Currently too many vulnerable children are ‘invisible’ to services and are missing out on the support that they need – we must do better and, to ensure that we do, we need more health visitors. We hope that this announcement marks the start of a shift in national policy that prioritises the critical first 1001 days of life. Vulnerable babies, young children and families live in every postcode, and further investment is needed to ensure that the Start for Life vision becomes a reality for the whole country.”

The iHV will be working with local authority areas to support the development of their evidence-based ‘Start for life’ offer and integrated pathways. We invite any local areas who are interested in our consultancy and sector-led improvement work to contact us for further information on bespoke packages of support at [email protected].

Further information on integrated pathways for perinatal and infant mental health (PIMH) support and the latest PIMH research can be found here, and the role of health visiting and who health visitors are can be found here.

Read the Government's news story

iHV welcomes LGA call for fresh investment into health visiting

The Institute of Health Visiting very much welcomes the LGA (Local Government Association) call for fresh investment into health visiting after the number of health visitors has declined very significantly over the past three years following reductions in public health budgets.

The health visiting service model needs to be based on proportionate universalism and ensure that support is available for all children and their families at all levels of need. Families lives change over time, hence so do their needs. The service must be sufficiently flexible to be available to families as and when it is needed.

The best way of achieving this is by families having continuity of care from one health visitor, having time to build a relationship with them and, as a result, being trusted by the family as a source of support. In this way, families feel confident in seeking help from the service should they need it, with health visitors also having ‘touch points’ with them for their child’s developmental assessments. It is also linked to increased identification of children in need and at risk of poor outcomes. It must be recognised that it takes time to build effective trusting relationships with families who often have multiple competing needs.

The health visiting service specification also needs to be sufficiently resourced to ensure the quality and quantity of provision needed to deliver effective prevention and early intervention. We strongly urge the government to put in place a more robust system for the future which removes the risk of future year-on-year cuts of the type happening now which have put a generation of children at risk and are likely to prove much more costly in terms of unrecognised health needs and late intervention in the longer term. As the LGA document Health visiting: giving children the best start in life demonstrates, some areas in England such as Blackpool have made it a priority to invest into their health visiting service despite their reduced budget, recognising the longer term benefits this will bring their citizens. Other UK countries, such as Scotland, have made investment into health visiting a policy priority to improve the status of child health and wellbeing across all of Scotland.

The evidence is clear – the most effective health visiting services use an asset-based, personalised whole family approach taking into account the context in which families live. On the contrary, the evidence is also clear that fragmenting people’s lives into individual problems, using a tick box, one-size fits all approach that diminishes the professional autonomy of the health visitor, is ineffective. We hope that any new investment will be used in a way to ensure that these essential components of the health visiting service are in place so that the service is once again able to deliver the outcomes for children and families which it can and should be.

Read LGA news story (March 2019): Urgent investment needed to halt decline in children's health visitors

Download LGA document: Health visiting: giving children the best start in life (March 2019)

‘The economics of health visiting: a universal preventative child and family health promotion programme’ report launched

The Institute of Health Visiting (iHV) is delighted to announce the publication of its new report “The economics of health visiting: a universal preventative child and family health promotion programme”, which reviews the economic impact of early intervention services on the lives of children, families and society.

This is a member only document. Non health visitors who work in public health related areas may join the iHV as Friends to access all our documents. As a charity, the iHV relies on its member income to produce such documents.

Early intervention is taking action as soon as possible to tackle problems for children and families before they become more difficult to reverse. According to the Early Intervention Foundation (EIF), damaging social problems affecting young people such as mental health problems, going into care, unemployment and youth crime costs the Government almost £17 billion a year. However, research has proven that investment in early childhood development saves long-term costs and improves children’s outcomes – and the earlier the investment, the greater the return.

Dr Cheryll Adams CBE, executive director of the Institute of Health Visiting, said:

“The earliest years of children’s lives have a powerful influence on their subsequent development and health, with benefits both to themselves and to society that last beyond childhood – and health visitors play a critical role in these early years.

Our report shows that early years interventions, such as those covered by the universal health visiting service, deliver both social and economic benefits, including reducing long-term costs and improving outcomes, as well as increasing the economic productivity of the population.”

The focus of health visiting, an advanced and specialist public health nursing service, is the whole population of children in the foundation years (from pregnancy to age five). In particular, health visitors engage on a universal basis with the families of all children in the first ‘1001 critical days’ from conception to age two. This is described as the ‘age of opportunity’ (WAVE Trust, 2014) when the impact of social and other adversity can become biologically embedded in brain development – showing in a child’s social, emotional, cognitive and physical developmental outcomes.

Dr Adams added:

“Investing in an early intervention service, such as universal health visiting, reduces inequalities in the earliest years of a child’s life – giving all children the most important thing, the best start in life.”

Download The economics of health visiting: a universal preventative child and family health promotion programme report