To mark the 10th anniversary of the transfer of public health from primary care trusts to local government, the Local Government Association (LGA) interviewed key people closest to the reforms on what they think has worked well, what can be improved on, and learnings to take forward for the future – including iHV CEO, Alison Morton.

Some of the interviews that the LGA conducted were deliberately challenging and provocative. Some of them present a picture of what is already happening in local government, whereas some of them look to what more local and national government could do in the future, either with additional powers or by using their existing powers and remit.

In Alison’s interview, she says:

“The role of the health visitor is unique. There is no other service which sees every family before the age of five. That puts them in a position to make a difference to people’s lives. Health visitors could play a crucial role in addressing the challenges of the cost-of-living crisis, but only if they are properly funded to do so… we can do it – in fact we cannot afford not to.”

iHV supports today’s call by the Local Government Association (LGA) for the Government to urgently publish local council’s Public Health Grant funding allocations. This is urgently needed to bring an end to the uncertainties around budgets for health visiting and other public health services.

A lack of certainty around councils’ public health funding that they will receive from April this year risks exacerbating the growing crisis of demand for support services that has built up as a result of the pandemic.

Alison Morton, Executive Director iHV, said:

“We support the LGA’s call for an end to the delays that are holding up the announcement of this year’s Public Health Great funding allocations – councils need to get on with their planning for this coming year.

“Across the sector we are also looking to this announcement for an uplift in the Public Health Grant and long-awaited investment in health visiting and school nursing services. In last year’s Spending Review submissions, more than 700 leading children’s organisations supported the iHV’s call for investment to enable local authorities to create strong and innovative health visiting services able to play their role in increasing opportunity for our citizens and reducing long-term burdens on the NHS.

“Babies cannot wait – the time to act is now, to reverse years of cuts to the service and a postcode lottery of support for families.”

Cllr David Fothergill, Chairman of the LGA’s Community Wellbeing Board, said:

“Demand for vital treatment for drug and alcohol misuse, obesity, mental health and children’s health is rising and at risk of not being met, while we are still grappling with the impact of the Omicron surge.

“It is wrong that we are still in the dark about how much there is to spend on this essential treatment and support, which will better protect our population from future pandemics. The Government should act now and publish councils’ public health grant without further delay, so that we can get on with planning ahead for an anticipated post-Covid surge in requests for help.”

Councils need to make critical decisions on renewing contracts for vital public health services, including for health visiting, sexual and reproductive health and suicide prevention, potentially leaving people without crucial help and support.

Last year, councils received their public health funding allocations on 17 March. Less than two weeks before the start of the new financial year. This must not be repeated.

With the International Year of the Nurse and Midwife being extended into 2021, we have another opportunity to celebrate the important work of health visitors.

Just in case you missed them, there’s a fab series of videos which showcase some of the great work that health visitors do – thanks to the Local Government Association (LGA) who recently published them alongside support from iHV and SAPHNA.

These videos highlight HV teams which have come up with new ways of supporting families during the pandemic. These case studies highlight some of the vital role that health visiting and school nurse services play in identifying problems early and giving children the best start in life.

Videos include:





We have received numerous enquiries from health visitors asking for greater clarity for the health visiting service during the COVID-19 pandemic.  The Institute is doing all we can to expedite this information for the profession and have a dedicated COVID-19 section of our website which we are using to provide updates as and when they are received. However, at the moment the content still lacks this much needed detail for health visitors’ roles.

We have contacted Public Health England, the Local Government Association and the Association of Directors of Public Health to highlight the need for advice to manage the numerous queries that we are receiving from health visitors, including service leads around emergency planning and escalation for the health visiting service – things like, “should we carry on with universal contacts?” “Will I be redeployed? And if so, when?” “What about families who have safeguarding concerns or high levels of vulnerability?” “Am I in a priority key-worker group?” etc…

The latest update that we have received from Public Health England is that the NHS is leading on drafting guidance on community services including health visiting. PHE and local government have provided advice and we are awaiting publication.  We will alert our members and followers when we receive advice that it has been published – hopefully very soon. As there is considerable pressure and pace within the healthcare system due to the pandemic, we suggest that you also keep a look out on the government COVID-19 update web pages and contact your local commissioner and Director of Public Health who will be coordinating the response to the NHS guidance in your area.

Our position at the iHV is that we need to support the government-led decisions (nationally and locally) rather than issuing our own guidance which may cause confusion and mixed messages at this time when clarity is needed.

We will continue to do all that we can to help.

A big thank you to everyone working in health visiting at this time. You are all doing an amazing job during the uncertainties of the COVID-19 situation – it is comforting to know that we have great teams of people who care so much about the communities they work in, and the health and wellbeing of families.

New government funding of £210 million for NHS nurses to improve their training and skills should be expanded to cover public health workers, such as health visitors and school nurses, councils say.

Institute of Health Visiting. Library Photography. Picture: Cleverbox /

Offering greater training and upskilling opportunities would also encourage more people into nursing and to stay in the profession for longer, at a time when the sector is experiencing severe problems in recruitment and retention.

iHV responds to Local Government Association (LGA)’s analysis on children’s social care, published today, which calls for Government to use the upcoming Spending Round to fully fund the demand on children’s services next year to allow councils to provide the vital support that children and families rely on.

Severe funding shortages and huge demand pressures mean councils were forced to overspend on their children’s social care budgets by nearly £800 million last year in order to try and keep children safe, the Local Government Association reveals today.

Dr Cheryll Adams CBE, Executive Director iHV, commented:

“The Institute has long warned that more children entering safeguarding procedures and care would be an inevitable consequence of cutting preventive services such as health visiting which identifies needs in families early, mobilises support for families in need and reduces long-term negative consequences of late identification for these children, such as safeguarding issues and care proceedings. These new figures should be of concern to the whole population as, as well as negatively impacting on the child his/herself and their potential future, these high levels of vulnerable children impact crime rates and criminal justice budgets and increase demand on the NHS from complex health needs.

“One in three health visitors has been lost over the past 4 years and the imposition of unhelpful new ways of working makes it impossible for the profession to adequately offer the necessary long term support that some families need. Alongside the LGA, we also call on the Prime Minister and Treasury to use the upcoming spending review to reinvest into public health, preventative and children’s services. The economic arguments are clear.”

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.


Published by Public Health England (PHE) and the Local Government Association, Good progress but more to do: teenage pregnancy and young parents provides case studies and practical information.

It is over 15 years since the then government launched its Teenage Pregnancy Strategy in response to England having one of the highest teenage pregnancy rates in Western Europe. Since then, thanks to the hard work of councils and their partners, the under-18 conception rate has dropped by 60 per cent and the proportion of teenage mothers in education and training has doubled.

As time has gone by it has become clear what works. Evidence shows that high quality relationships and sex education (RSE), welcoming health services (in the right place, open at the right time) and friendly non-judgmental staff, help young people to delay sex until they are ready and to use contraception effectively.

Today the Local Government Association (LGA) launched Public health transformation five years on: transformation in action – the fifth in their series of annual reports.

Public health has been part of local government for five years now. We are well beyond the stage at which public health teams have ‘bedded in’ to local authorities and at which local authorities have learned what public health is all about.

Born of the synergy between the two, we should now expect to see significant changes in the way local government carries on its business; and significant changes in the understanding of public health teams of the potential breadth and depth of their reach in tackling the social determinants of health.

This report from the Local Government Association (LGA), produced in partnership with Public Health England, highlights the specific needs and challenges for health and care provision in rural communities. The report includes case studies showcasing the ways in which local authorities in England are tackling health inequalities, improving access to services and building up community resilience.