Waiting for policy announcements is a bit like waiting for buses. Yesterday saw the long-awaited announcement of the local authority public health grant settlements, and this was followed swiftly today with Sajid Javid’s announcement of the elective recovery plan for the NHS.

The announcements lay bare the glaringly different priorities afforded to ‘sickness treatment’ in the NHS and the poor relation of preventative public health and early intervention.

It has been estimated by the NHS that 10 million people did not seek treatment during the pandemic, and around 6 million people are waiting for elective treatment. To address this backlog, Sajid Javid says the government has already allocated an extra £2bn to tackle waiting lists this year, with another £8bn being spent over the next three years – alongside this, there is a further £6bn of spending announced for capital investment in the NHS.

In contrast, England’s public health grant allocation for 2022-23 saw a 2.81% rise to council’s public health budgets, which brings total funding to £3.42bn in 2022-23, up by £93m from 2021-2022. The Government had previously pledged to maintain public health funding in real terms in the autumn budget, however, when compared to the current rate of inflation of 5.4%, this settlement represents a cut in real terms.

Recently, Sir Michael Marmot said: “It shouldn’t be that we either invest in treatment services or improving public health, we need to do both if we want to create better societies for people.”

Alison Morton, Executive Director iHV, responded:

“Yesterday’s funding settlement for local authorities in England is not good news. With long-standing workforce shortages, rising levels of vulnerability and a backlog of babies, children and families missed in the pandemic, this is another blow for public health. Where is the public health recovery plan?

“Our role at the iHV and as health visitors is not to be party political but to stay true to the key principle of health visiting to ‘Influence policies affecting health’ – and it is in our view that the Government needs to reconsider its priorities for babies, children and families as a matter of urgency. Whilst we are all acutely aware of the costs that this country faces in the wake of the pandemic, to gain perspective we need to view these decisions in the light of other policy decisions. In the autumn Spending Review, the price of a pint of beer was cut by 3p – this came at a cost to the Treasury of £3bn.”

We have escalated our concerns in a recent letter to the Minister, Maggie Throup, and officials in the Office for Health Improvement and Disparities. Whilst we welcome their plans for a workforce roundtable in February and the commitment of £10m for workforce pilot schemes, action is urgently needed to address the much bigger problem posed by the ever-increasing health visitor workforce shortages now – this cannot wait for another 2 years for these pilots to report their findings. Babies, young children and their families are at risk because we know that we have a shortfall of about 5,000 health visitors and this is having a significant impact on the service and the level of support offered to them.

Following the success of the first two webinars, watched live by over 1,000 attendees combined, the Genomics Education Programme, NHSE/I and the RCNi would like to invite you to join the third and final part of their free webinar series on 8 September.

 

This final webinar in the series will feature a range of speakers looking at how genomics is being applied to healthcare and opportunities available for learning, including a look at courses and resources designed to show health professionals how genomics is and will be used in specific areas of practice.

The webinar will be chaired by Professor Chris Morley, Chief Nurse for the North East and Yorkshire NHS Genomic Medicine Service Alliance, with opening remarks delivered by Professor Mark Radford, Chief Nurse for Health Education England.

For those health visitors who have an interest in genomics, Sally Shillaker will be speaking about genomics and the health visiting role during the webinar.

This webinar is CPD-certified and will allow you to gain two hours of participatory CPD towards your revalidation.

To find out more or to reserve your free space now, please visit the registration page.

The Institute of Health Visiting wishes a very happy 73rd birthday to our fabulous NHS. In recognition of the enormous contribution that the NHS has made to the health and wellbeing of the country, the Queen has awarded the George Cross to the NHS as the service marks its anniversary today.

In a personal message, the Queen said NHS staff across the UK had worked “with courage, compassion and dedication” for more than 70 years.

 

The Duke of Cambridge is hosting a Buckingham Palace tea later to thank NHS workers.

The awarding of the George Cross by the Queen is made on the advice of the George Cross Committee and the prime minister. This latest award is only the third time the George Cross has been given to a collective body, country or organisation, rather than an individual.

On 31 July, plans for the next – third – phase of the NHS response to the COVID-19 pandemic, effective from 1 August 2020, were set out in a letter from the Chief Executive Sir Simon Stevens & Chief Operating Officer Amanda Pritchard; this includes providers of community services.

The Government has agreed that the NHS Emergency Preparedness, Resilience and Response (EPRR) incident level will move from Level 4 (national) to Level 3 (regional) with effect from 1 August. This approach matches the differential regional measures the Government is deploying and builds on the guidance set out in the COVID-19 restoration of community health services for children and young people: second phase of NHS response to fully restore [the health visiting] service, with some prioritisation where indicated and as capacity dictates”.

The priorities for this phase are:

  1. Accelerating the return to near-normal levels of non-Covid health services, making full use of the capacity available in the ‘window of opportunity’ between now and winter
  2. Preparation for winter demand pressures, alongside continuing vigilance in the light of further probable Covid spikes locally and possibly nationally.
  3. Doing the above in a way that takes account of lessons learned during the first Covid peak; locks in beneficial changes; and explicitly tackles fundamental challenges including: support for our staff, and action on inequalities and prevention.

Hot off the press is the updated Prioritisation of Community Health Services – “COVID-19 restoration of community health services for children and young people: second phase of NHS response“.

We are delighted to see greater prioritisation of the role of health visitors as an essential part of the country’s support structure for children and their parents during this public health pandemicIn particular we welcome:

  • The removal of the wording around redeployment of health visitors
  • The reinstatement of the health visitor 6-8 week review
  • The inclusion of additional safeguards to protect vulnerable children – “Face-to-face contacts should be prioritised for families who are not known to services to mitigate known limitations of virtual contacts and support effective assessment of needs/ risks”
  • Prioritisation of home visits where there is a child safeguarding concern.
  • Reinforcement of messages that “routine and selective immunisation programmes should be maintained. This includes the seasonal flu programme”.

This document supersedes the prioritisation guidance for community health services first published on 20 March and subsequently updated on 2 April.

 

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.

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) has published its response to the consultation – Mental Health in the Long-Term Plan for the NHS.

The consultation is to identify opportunities to deliver the NHS’s goal to provide world-class mental healthcare – improving the outcomes for everyone who uses the NHS services.

Dr Cheryll Adams CBE, Executive Director, Institute of Health Visiting said:

“At the Institute, we firmly believe there is no health without mental health, which is why we have perinatal and infant mental health (PIMH) as a priority focus. We welcome the opportunity to respond to this consultation to ensure that all families get consistent, accessible, high quality care and support for their mental health during the perinatal period. Our response reflects the many consultations and surveys we have done with our members and other stakeholders over the recent months and years.”

The Institute’s response includes its top three priorities in mental health:

  • Resourcing health visiting services through joint commissioning which formally requires health visitors to take a specific lead for perinatal and infant mental health;
  • Closing the gap between knowledge of what affects child and family mental health, and how services are commissioned and organised to implement this knowledge;
  • A need to concentrate efforts to create a much wider understanding of the epidemiology of mental illness with so much of it having its origins in the very first years of life.

Dr Adams continued:

“Early intervention for families in the perinatal period will reduce the burden of mental illness across the life-course! We have to get that message over to politicians and policy makers, so that funding is allocated upstream and not disproportionately spent on secondary and tertiary care, fixing problems that could have been prevented from occurring in the first place.

“This submission focuses on how, with the right support from the NHS and partner organisations, health visitors can ensure that all families with children receive the right care and support for their mental health, at the right time, in the right place.”

 

The Institute of Health Visiting (iHV) has published its preferred plan for the relationship of health visiting with the NHS in the next 10 years.

 

As the NHS writes its new 10-year plan, with a specific focus on children, prevention and mental health, the Institute of Health Visiting has published its own recommendations for strengthening health visiting services alongside.

 

 

 

 

Dr Cheryll Adams CBE, Executive Director, Institute of Health Visiting said:

“Health visitors have a vital role in delivering early preventative services for infants and children, and in supporting parents through the emotional challenges of early parenthood. Unless there is a plan to strengthen health visiting services alongside the new NHS 10-year plan, it will be impossible to deliver on many of what we expect to be its worthy ambitions. We hope that our rationale, and the recommendations in our new position statement, will be taken seriously by those writing the plan.

Dr Adams continued:

“Moving health visiting commissioning completely from the NHS to local authorities, in October 2015, has created many challenges for the quality of services that health visitors have been able to deliver, and for the essential relationships that health visitors need to have with NHS partners. Part of the challenge has come from cuts to public health budgets, but it’s more complex than that – the loss of close relationships with NHS services, in particular with general practitioners, has also been very unhelpful.

“Three years of the local authority commissioning model has seen a loss of around 20% of the workforce and worryingly high levels of grade mix.  Therefore, we are proposing a new joint NHS/Local Authority governance/commissioning model – this we hope will avoid such challenges for services to our most vulnerable members of society in the future.

Further recommendations

“Other recommendations include that every family should have at least nine universal contacts. This requires new investment into the profession, but that will be more than offset by savings in preventable treatment costs in later life. Nine core universal contacts being delivered by health visitors is becoming the norm for Welsh families, with Scottish families receiving eleven! This is based on the evidence of what can be achieved by providing robust health visiting services during the very early years – and English children shouldn’t be disadvantaged.”

Dr Adams concluded:

“Our position statement makes clear what we believe needs to happen to improve outcomes for children through strengthened health visiting – with a renewed focus on children’s services, improving mental health and prevention and reducing inequalities in the essential early years period. We are circulating it widely to decision makers and those concerned about giving every child the best start in life.”

 

 

Health Education England has worked in partnership with Public Health England to transfer the NHS Screening Programmes’ e-learning modules on to the e-Learning for Healthcare (e-LfH) online platform.

There are 11 NHS Screening Programmes in England. These programmes are commissioned and managed based on the recommendations provided by UK National Screening Committee.

Screening is a way of identifying people who are at higher risk of a health problem, so that treatment can be offered or information given to help them make personalised informed decisions about their care.

Healthcare professionals use e-learning as part of their training and continuing professional development and the new platform allows them to have all their NHS e-learning training in one place.

The e-learning, which was previously available on the CPD Screening website, is regularly updated to reflect national standards.

This e-learning offers comprehensive training for healthcare professionals who offer screening to:

  • pregnant women
  • newborn babies
  • adults (abdominal aortic aneurysm).

It does not currently include e-learning for Cancer Screening or Diabetic Eye Screening, but will in future.