Government’s own data confirm scale of health visiting workforce crisis, yet no plan has been set out to address it

The Institute of Health Visiting (iHV) has welcomed the publication of long-awaited new national health visiting workforce data which provide much greater transparency on the state of health visiting in England. Despite the growing political focus on babies and the early years, England is falling behind the other UK nations on health visiting and there is still no workforce plan to deliver the Government’s ambitions to strengthen health visiting.

With ministers expected to set out their priorities for the NHS at the Labour Party conference next week, the Institute of Health Visiting is calling on the Government to ensure health visiting is not left behind yet again. Successive years of underinvestment have weakened a service that is proven to improve outcomes for babies, children and families, reduce pressure on other parts of the health system and deliver long-term value for taxpayers. Families cannot afford another missed opportunity.

Key messages:

The Government committed to strengthening health visiting in its manifesto commitments in 2024. Yet, the Government’s own data now confirm that England’s health visiting services are rapidly falling behind those provided to families in the other UK nations.
The Government’s figures confirm the scale of the problem and the consequences for families. The data confirm significant workforce losses, enormous caseloads, and stark variation in access to health visiting services across England. The figures provide the clearest picture yet of the pressures facing health visiting services and their impact on babies, children and families.
The Institute of Health Visiting welcomes the transparency in new workforce data but warns there is still no plan to fix the crisis.
Health visiting is not a cost burden; it is a cost-saving investment. The costs of late intervention are already spiralling out of control, placing growing pressure on public services and the public purse. Maintaining the status quo is not cost neutral. Failing to invest in prevention simply stores up greater costs for children, families and society both now and in the future.

For many years, the iHV has called for improved workforce intelligence, warning that the absence of robust national data risked obscuring the scale of workforce pressures in England and delaying action to address them. The findings lay bare a bleak picture, with the provision of health visiting services in England rapidly falling behind the other UK nations.

Published by the Department of Health and Social Care, the new data estimate a workforce of 6,909 whole-time equivalent (WTE) health visitors in England and reveal significant variation in staffing levels and caseloads between local areas. iHV analysis of comparable government workforce data shows that the number of health visitors has fallen by around two-fifths since 2015.

Nationally, there are 2.2 WTE health visitors per 1,000 children aged 0 to 5 years, but local authority rates range from 0.9 to 4.9 health visitors per 1,000 children, more than a five-fold difference between the lowest and highest staffed areas.

For families, this means access to health visiting support can vary significantly depending on where they live. Ultimately, babies, children and parents pay the price when overstretched services lack the capacity to provide the preventative and early intervention support that families need – before problems escalate and families reach crisis point.

The data also highlight the scale of variation in health visitor caseloads. Average caseloads stand at 454 children per health visitor, but average caseloads range from 204 to 1,111 children across different areas of England.

Such variation has a direct impact on the quality and consistency of support available to families. Health visitors carrying very large caseloads have less time to spend with each family, fewer opportunities to build trusted relationships, and reduced capacity to provide the preventative and early intervention support that is at the heart of the Healthy Child Programme.

The iHV is particularly concerned that, in some areas, service models and workforce shortages mean that families may never see a qualified health visitor. While wider skill mix teams make an important contribution, all families should be able to access the specialist expertise of a qualified health visitor when needed.

The findings come despite the Government’s manifesto commitment in 2024 to strengthen health visiting services and at a time of growing recognition of the importance of supporting children during the earliest years of life. While Scotland, Wales and Northern Ireland have maintained national commitments to strengthening their health visiting workforce, England has yet to set out a comprehensive strategy to rebuild capacity, leaving it increasingly out of step with the other UK nations.

The iHV is calling on the Government to avoid any further delays and publish its plan to rebuild health visiting services in England.

Health visitors will be central to delivering the Government’s ambitions for ‘Healthy Babies’, reduced inequalities, and stronger Family Hubs. The iHV is therefore calling for a fully funded national workforce strategy to ensure services have the capacity needed to deliver on these priorities.

Alison Morton OBE, CEO of the Institute of Health Visiting, said:

“We welcome the publication of this long-awaited workforce data. Government has now published its own evidence, and it confirms what health visitors and families have been experiencing for years: there are simply not enough health visitors to meet growing need.

“Workforce shortages and excessive caseloads mean that too many families are unable to access the support they need during the crucial early years of a child’s life.

“The evidence is now clear. If the Government is serious about its commitment to strengthen health visiting and deliver its ambitions for babies, children and families, we now need a clear, funded plan to rebuild the workforce.”

Department of Health and Social Care Children’s public health nursing: workforce and activity report, 2025

First 1001 Days Movement’s Manifesto for Babies

The iHV is proud to be a Steering Group member of the First 1001 Days Movement and fully supports its Manifesto for Babies. The recommendations are published in advance of the general election to coincide with Infant Mental Health Awareness week this week (10-16 June 2024) and our shared pledge to #SpeakUpForBabies.

The First 1001 Days Movement comprises a coalition of over 200 charities and professionals who believe that babies’ emotional wellbeing and development matters. The Movement’s members deliver a wide range of services that protect and support babies and their families – and the recommendations for the next government are based on a survey of its membership.

At the iHV, we are delighted to have the weight of support of more than 200 organisations and individuals within the Manifesto calling for sustainable funding for health visiting. We know that it takes a village to raise a child and health visiting is only part of the solution. Collectively, we recognise the importance of a comprehensive system of support to meet the needs of all babies – with the following recommendations:

1.An ambitious cross-government strategy to support babies’ healthy development

A Cabinet Committee made up of relevant Secretaries of State, reporting to the Prime Minister, to join up government
An ambitious cross-government strategy for babies that aligns government departments to work towards common outcomes.

2. Invest more in prevention

Sustainable funding of preventative services, including health visiting, with public health budgets ring-fenced from day-to-day and capital spending
The Treasury to recognise the full benefits of services that improve outcomes in both the short and long term and across departments
Extending funding for the Start for Life programme until every neighbourhood has a Family Hub or Children’s Centre
The NHS Long Term Plan to include preventative mental health services for babies.

3. Tackle health inequalities so that all babies have a good start to life

A national strategy to support babies in the first 1001 days should include targeted approaches to reduce inequalities
The next government to commit to tackle child poverty and scrap the two-child limit policy
Integrated Care Systems to be held accountable for their statutory duty to reduce health inequalities and invest in services that support babies’ social and emotional development
Services to be co-produced with families to reach the most vulnerable babies in marginalised and isolated families.

4. Develop a workforce plan for children’s social care and the early years

Adequate staffing levels to support babies and provide safe care in all settings
Collaborating with professional bodies to accurately estimate and address workforce gaps across services
A workforce plan for social care and the early years workforce to complement the NHS Workforce Plan
A review of training pathways to explore new entry routes to careers in the NHS, early years, social care and the voluntary sector.

5. A rapid review of the tax and benefits system for parents and carers of under-2s

Government to recognise that supporting babies’ healthy development is equally important a policy objective as getting new parents back to work
Parental choice to return to work to be supported
Government to provide six weeks’ well-paid paternity and parental leave to help fathers play a more active role
Training in infant mental health for nursery staff and all those working in paid settings caring for under-2s.

Read the full First 1001 Days Manifesto report here.

Get involved – ask your candidates to support the campaign – see details here.

In case you missed it, you can also read the iHV manifesto “asks” for health visiting, published last week, here.

General election 2024 – what we want from the next government

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.

Asks:

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.
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.
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.

For more information on the importance of health visiting, read: The role of the health visitor, where are we now?

Watch our short film: “Health visiting in your community”

To understand how cuts to health visiting impact families and other services, watch our iHV film on soaring rates of A&E attendance in children aged 0-4, “Can you see my baby? Health visitors prevent emergencies”

iHV joins UK charities’ call for action to address decline in babies’ health

Today, the First 1001 Days Movement, a coalition of over 200 charities and professionals, including the Institute of Health Visiting, published a ‘Manifesto for Babies’. The manifesto calls on all political parties to invest in prevention, demanding urgent support for vulnerable babies amid growing concerns about the health and welfare of Britain’s youngest.

The appeal follows last month’s warning from the Academy of Medical Sciences that the UK is “betraying” young children, by neglecting their essential physical and mental health needs.

The charities warn that a failure to act now will create “a ticking time bomb” that hits when children start school. The manifesto is published ahead of what is set to be the most crucial election for babies.

The manifesto recommendations include:

An ambitious cross-government strategy to support babies’ healthy development, with a dedicated Cabinet Committee reporting directly to the Prime Minister, to ensure cohesive action.
Sustainable funding for preventative services, including health visiting, and extending funding for the ‘Start for Life’ programme.
Action to tackle health inequalities so that all babies have a good start to life – including targeted approaches to reduce inequalities and a commitment from the next government to tackle child poverty.
Develop a workforce plan for children‘s social care and the early years, alongside delivering the NHS Long Term workforce plan.
A rapid review of the tax and benefits system for parents and carers of under-2s, with increased paid paternity and parental leave, alongside training nursery staff on infant mental health

Local services are worried by the worsening health of the babies and young children they see:

Toddler development in England has declined over the last five years, with 1 in 5 two-year olds now below the expected level of development.
Slow development impacts on school readiness, with latest data showing 2.5 hours of teacher time is lost every day because children are not ‘school-ready’, and one in four children starting reception are not toilet trained.
The charities warn an estimated 10% of babies in this country are living in fear and distress because of disturbed or unpredictable care, and that one in five babies is missing the mandatory one-year old health visitor check where problems can be picked up early.

Evidence shows that the first 1,001 days of a child’s life, from pregnancy to age two lay the foundations for a happy and healthy life. The support and wellbeing of babies during this time is strongly linked to better outcomes later in life, including educational achievement, progress at work, physical and mental health.

Commenting on the “Manifesto for Babies”, Alison Morton, CEO Institute of Health Visiting, said:

“The next government must prioritise the health of our babies and young children. The current situation is deeply concerning as the health of our nation’s children has now plummeted to the lowest rankings amongst other comparable nations. Health visitors see the human face of these statistics every day. With more young children falling behind with their development and being harmed by conditions that are entirely preventable, there is a clear imperative to act.

“We urge all parties to listen to the collective voice of the First 1001 Days Movement coalition of more than 200 organisations captured in this manifesto. In particular, their call for urgent investment in health visiting to ensure that all babies and young children get the support that they need to thrive and to restore this vital safety-net for the most vulnerable.”

Keith Reed, Chief Executive at The Parent-Infant Foundation, said:

“Ignoring the needs of vulnerable babies leaves a ticking time bomb that hits when children start school. With the electoral battleground heating up, crucial services for babies hang in the balance. Start for Life cannot be allowed to suffer the same fate as Sure Start. As babies can’t vote, it’s crucial that we speak up for them. Investing in babies’ wellbeing is not only the smart thing to do from a policy perspective, it’s a moral imperative.”

Read the full Manifesto for Babies here

About the Manifesto for Babies

The Manifesto for Babies is published by the First 1001 Days Movement – a coalition of over 200 charities and professionals who believe that babies’ emotional wellbeing and development matters. Our members deliver a wide range of services that protect and support vulnerable babies and their families. These recommendations for UK policymakers are based on a survey of the First 1001 Days membership.

The Manifesto for Babies was developed by a Steering Group comprised of NSPCC, the National Children’s Bureau, Home-Start UK, the Institute of Health Visiting, the Anna Freud Centre, AiMH-UK, the Association of Child Psychotherapists, SANDS, Blackpool Centre for Early Child Development, Best Beginnings, Future Men, Approachable Parenting, Fatherhood Institute, Oxpip, the Parent-Infant Foundation and elected individual experts; Professor Eunice Lumsden, Bethany Boddy and Emma Carey.

iHV responds to the Labour Party’s Child Health Action Plan

Following yesterday’s launch by the Labour Party of their “Health Mission” in Manchester, the party has published its Child Health Action Plan. Labour’s ambition is for this to be the healthiest generation of children ever.

Labour’s Child Health Action Plan to:

Cut waiting lists for children
End the crisis in child mental health
Transform NHS dentistry
Crackdown on smoking and vaping
Ban junk food advertising to children
Introduce breakfast clubs for all primary school children
Protect children from the growth of infectious diseases
This includes delivering on the NHS workforce plan, training more health visitors so parents and babies get the best possible support. Plus reforming the service to allow health visitors to administer routine immunisations to vulnerable and at-risk children, ensuring more are protected from infectious diseases.

Alison Morton, iHV CEO, responded to the Labour Party’s Child Health Action Plan:

“We are delighted to see that the Labour Party is pushing ahead with their plans to grow the health visitor workforce in their Child Health Action Plan. This will build capacity in the service to tackle a wide range of inequalities in child health, as well as supporting families to access healthcare – for example, to improve immunisation uptake for families who do not currently experience easy access to services (and consequently often experience the worst health outcomes), reduce pressures on A&E departments for minor illnesses, and improve oral health. These have always been part of the role of health visitors but have fallen by the wayside in many areas, as services have been reduced to “firefighting” and child protection due to serious workforce shortages.

“If we’re serious about improving the health of our nation’s children, it is imperative that health visitors get back to their core “health” function, working with families to prevent, identify and treat problems before they reach crisis point.”

At the iHV, we have been working with all political parties and government officials to ensure that the health of our nation’s babies and young children is taken seriously. We have shared our Vision for health visiting and call for more health visitors as an important part of the solution to tackling the current poor state of child health and widening inequalities. We will continue in our efforts to influence policies affecting health as all parties set out their manifesto plans for child health ahead of a general election expected this year.

Read Labour’s Child Health Action Plan

iHV welcomes Early Years Commission – A Cross-party Manifesto

We’re delighted to see yesterday’s cross-party support for the early years published in the Early Years Commission: A cross-party manifesto – #EarlyYearsManifesto. Yet more evidence for the case for investment.

Alison Morton, Executive Director iHV, who provided evidence on health visiting as a witness to the commission commented:

“The importance of getting it right for every child cannot be over-emphasised. I am delighted to see such strong cross-party agreements and a cross-departmental commitment to prioritise the earliest years of life set out so clearly in this report. The commission has highlighted the importance of tackling the root causes of siloed working alongside the benefits of investing early, rather than ‘firefighting’ and tackling emergencies. With so much attention on the early years at the moment, action to start to put this right cannot come soon enough”.

The manifesto outlines how our country must give every child the best start in life, and right now we are falling short. Despite improvements among some children, too many continue to fall behind in their first few years, particularly those living in poverty. Many are not ready to learn by the age of five and struggle with their health and wellbeing, leading to damaging long-term consequences. It is this reality which obstructs our country’s path to a more prosperous future. We will never truly level up if we don’t recognise this. There are steps we can take now to help those children, even though they and we may not realise the benefits for decades.

It is good to see health visitors mentioned as a key workforce that requires strengthening in order to achieve these ambitions.

Through their Cross-party Manifesto, The Early Years Commission calls on central and local government, community organisations, the private sector, parents, and society as a whole to come together to achieve this goal.

Read Early Years Commission: A cross-party manifesto

iHV welcomes manifesto pledge to increase the number of health visitors

The Institute welcomes the pledge made in the Labour Party Manifesto to increase the number of health visitors and school nurses by 4800 and hopes that the other parties’ manifestos will contain similar commitments.

Children in the UK have some of the worst outcomes when compared to the rest of Europe and similar countries across the world. Its time for all political parties to take this seriously. The Institute has published “Health Visiting in England: A Vision for the future” which sets out how a robust health visiting service can provide an important part of the solution for children and also help the delivery of many of the usual government targets.

iHV calls for manifesto pledges for children

The Institute of Health Visiting (iHV) has written an open letter which challenges the main political parties in England to commit to important manifesto pledges for children which it hopes to see from the next government.

Children in the UK have some of the worst outcomes when compared with the rest of Europe and similar countries in the world. It’s time for solutions, our children cannot wait any longer.

Dr Cheryll Adams CBE, Executive Director iHV, said: “The outcomes from disinvestment in preventative services for children are increasingly stark. In the words of Nelson Mandela, ‘The true character of a society is revealed in how it treats its children’. There is no doubt that England needs to do much much better. Children are our future, get it right in the early years and all of society benefits.”

Now is the time for solutions:

A few weeks ago the Institute published “Health Visiting in England: A Vision for the future” which sets out how a robust health visiting service provides an important part of the solution to a multitude of government priorities, with 18 recommendations.

Of these, the three most urgent requests are:

Local authorities need to receive urgent and ring-fenced public health investment to cancel planned cuts to the health visiting profession this year and next.
A review of 0-5 public health funding is needed with a new mechanism for sustainable funding in England. A shift in emphasis in language and policy is needed, from “releasing efficiencies”/ short-term return on investment in 0-5 public health, to a recognition by government that investment in prevention and early intervention in the early years is a sound investment in our children’s and society’s futures.
Urgent action is needed to rebuild the health visiting workforce, training 5000 health visitors is estimated to cost £137million. The public health grant would then need an uplift of £240million to cover these substantive posts. These costs are relatively insignificant against the cost of not intervening as set out in our Vision.

Read iHV’s letter to the political parties

Follow and support #FutureofHV on social media

iHV warmly welcomes NCB’s Manifesto for a Better Childhood

We are delighted to share the National Children’s Bureau’s Manifesto for a Better Childhood .

It’s a very comprehensive document making a call to the next government in all the necessary areas for children – including a call to: Invest in a world-class health visiting service for new parents, so all families can build a trusting relationship with their health visitor.

Download National Children's Bureau's Manifesto for a Better Childhood

New NHS Alliance manifesto for health creation

The New NHS Alliance (NNHSA) has set out their vision and road map for Health Creation in a ground-breaking Manifesto, which sets out 10 high impact recommendations to create a wellness-based health system, aimed at tackling the continuing problem and social injustice of health inequalities.

The Manifesto explains what Health Creation is, contains many stories of health creation and explains how practices can change to become health creating. It calls for

The adoption of health creating practices
System reforms to support health creation
Enhanced education on health creation

It contains the 3 Cs of health creation- Control, Contact, Confidence – (which complement the nurses’ 6 Cs), 5 health creating practices and 10 High Impact Recommendations for a health creating health system.

Download New NHS Alliance Manifesto for Health Creation

The Alliance has established a social movement for health creation, called Active Alliance and they are extremely happy to work alongside other organisations working on wellness.

Heather Henry, Chair of the New NHS Alliance, is very willing to speak at events, write and discuss at relevant meetings.

Please tweet about this using the hashtag #HealthCreation