Casting Long Shadows Report

The ongoing impact of the COVID-19 pandemic on babies, their families and the services that support them.

A brand-new report by the First 1001 Days Movement and the Institute of Health Visiting has been published today – ‘Casting Long Shadows: The ongoing impact of the COVID-19 pandemic on babies, their families and the services that support them.’

The report reveals worrying new statistics about babies and young children born or growing up through the COVID-19 pandemic, highlighting how more young children are at risk of harm, have delayed social skills, and have been affected by poor parental mental health.

The report findings were synthesised from evidence in recently published reports, research and national data, as well as analysis from a national survey of 555 professionals and volunteers who work with babies and their families in health visiting, mental health, maternity, early education, and other services.

The findings are compelling and are consistent with a whole raft of studies from multiple sources across the children’s sector, which all indicate that the wide-reaching impacts of the pandemic are far from over for our youngest members of society:

An alarming 94.8% of professionals say the pandemic has an ongoing negative or very negative impact on the personal and social skills of children who were living in the pandemic. 92.4% of professionals say the same for communication, speech, and language skills and for emotional wellbeing and development.
Almost half (42.7%) of respondents surveyed stated that “many” babies they work with are affected by parental anxiety, stress, or depression due to the pandemic, which is affecting bonding and responsive care.
More than 4 in 10 (44.1%) of respondents said that “many” of the babies they work with are currently affected by increased exposure to domestic conflict, child abuse and neglect.
4 in 10 (40.4%) survey respondents reported “many” babies they worked with had been affected by the loss of family income or increased risk of food poverty.

The report also highlights how:

Services have not returned to normal, and this could impact future generations – Whilst there has been innovation in service provision, nearly 6 in 10 respondents (59.5%) who reported that their service was operating differently, told us that the changes were not beneficial for families.
Services are in ‘crisis’ – The pandemic exacerbated existing strains on services. A significant number of survey respondents raised issues relating to low staffing numbers and poor staff wellbeing, with some professionals talking about services being in “crisis”.
The majority of respondents (90.5% in England) did not feel that national or local governments had taken sufficient action to ensure that babies under two and their families receive the support they need to recover from the impact of the pandemic.

With so much compelling evidence, The First 1001 Days Movement and Institute of Health Visiting are calling for:

National Government to take concerted action to address the impacts of the pandemic on our youngest children.
Integrated local strategies are needed to ensure that all children have the best start in life.
National Governments must have long-term child health and development strategies, supported by workforce plans.
Clear leadership within the UK Government is needed to ensure policy decisions include a cross-government focus on the needs of babies and young children. To ensure that this does not fall in the gaps between departments, a cabinet member should be appointed to drive this forward and act now to mitigate the impacts of the pandemic on our youngest citizens.

Alison Morton, iHV Executive Director, said:

“This report helpfully pulls together the unequivocal evidence that the pandemic’s impacts on our babies and young children have been significant and demand much greater attention from policy makers. What happens during these critical earliest years of life really does matter as they lay the foundations for future health and wellbeing. Yet, the report paints a bleak picture for babies in the UK. Too many are missing out on vital early support that can make such a difference. Ignoring this growing problem of unmet need and avoidable harms is short-sighted and will prove more costly in the long run.”

Georgina Mayes, Policy and Quality Lead at the Institute of Health Visiting, said:

“This new report clearly shows that the pandemic is having a lasting impact on many children’s health, wellbeing and development, and on the ability of services to meet their needs. More children are falling behind, inequalities are widening, and some services are reaching a crisis point. Whilst many professionals are working hard to support the families that they work with, this report clearly shows that demand is outstripping the workforce’s capacity to meet the scale of need.

“We call on national and local governments across the UK to take the findings of this research seriously and act now to mitigate the impact of the pandemic on our youngest children’s lives and life chances.”

Read the full report here

Health visiting study seeks to learn lessons from pandemic

A new £265,000 study led by the University of Stirling is seeking to understand how the COVID-19 pandemic has affected health visiting services across the UK, with a view to improving them in the future.

The 18-month project – funded by the National Institute for Health and Care Research (NIHR) – will explore the changes that health visiting has experienced over the past two years and provide recommendations to enhance organisation and delivery as part of a strong post-pandemic recovery.

The project is led by Dr Erica Gadsby, a Senior Lecturer in Public Health from Stirling’s Faculty of Health Sciences and Sport, and also involves researchers at the Universities of Oxford and Kent.

Alison Morton, Executive Director of the Institute of Health Visiting, said:

“Congratulations to the team, led by the University of Stirling, which has been awarded this prestigious NIHR funding.

“The last two years have been a period of tumultuous change, with health visiting services facing significant challenges in their efforts to support babies, young children and families. Health visitors responded rapidly with service innovations, but many of these adaptations have not been tested in the health visiting context and their impacts are largely unknown.

“This much-needed realist review will help us to gain a greater understanding of the pandemic response in order to learn lessons that can be applied to future emergencies, as well as strengthening the evidence base to support the embedding of new innovations and ways of working.”

The pandemic caused enormous pressure and disruption to child health services, as well as to families and young children, but it also prompted some important innovations in service delivery. The new study will explore how the pandemic affected health visiting services in Scotland, England, Northern Ireland, and Wales, with a view to understanding how the organisation and delivery of services can be improved for a stronger post-pandemic recovery.

The researchers will undertake a ‘realist review’, which is a type of theory-driven review of evidence. They will pull together different forms of information related to what has happened in health visiting services since March 2020 and use that to explore how the pandemic has affected services, service providers and families.

The team includes realist review, health visiting and public health experts, as well as a patient and public involvement lead. A stakeholder group – comprising practitioners, commissioners, policymakers, policy advocates, and members of the public – will advise and provide feedback throughout the project.

The team will work closely with the Institute of Health Visiting and the stakeholder group to ensure the findings of the study are developed into a range of outputs suitable for the various stakeholders and disseminated to the appropriate audience.

Dr Gadsby is supported on the project, Realist Review: Health Visiting in Light of the COVID-19 Pandemic Experience (RReHOPE), by Professor Kendall; Dr Geoff Wong and Ms Claire Duddy (both of the University of Oxford, Nuffield Department of Primary Care Health Sciences); and Mrs Madeline Bell (expert by experience).

Ofsted Early years report – continued impact from pandemic

Today, the Government published the second set of four reports in a series looking at the pandemic’s continued impact on education recovery and how schools, prisons, early years providers and further education and skills providers are responding to the impact of the COVID-19 pandemic.

The ‘Education recovery in early years providers: spring 2022’ report draws on inspection evidence gathered in the spring 2022 term and discussions with early years inspectors about the ongoing implications of the pandemic on children.

The pandemic has continued to affect young children’s communication and language development, with many providers noticing delays in speech and language. Others said babies have struggled to respond to basic facial expressions, which may be due to reduced social interaction during the pandemic.

The negative impact on children’s personal, social and emotional development has also continued, with many lacking confidence in group activities.

Children’s social and friendship-building skills have been affected. Some providers reported that toddlers and pre-schoolers needed more support with sharing and turn-taking. To address this, staff were providing as many opportunities as possible for children to mix with others and build confidence in social situations.

There continues to be an impact on children’s physical development, including delays in babies learning to crawl and walk. Some providers reported that children had regressed in their independence and self-care skills. As a result, several have increased the amount of time that children spend on physical activities, to develop gross motor skills.

An increasing number of providers were concerned that, compared with before the pandemic, fewer children have learned to use the toilet independently. This means that more children may not be ready for school by age 4. Providers were also concerned about obesity and dental health, so have focused on providing well-balanced meals and increased time for physical activity.

Alison Morton, iHV Executive Director said:

“Today’s report lays bare the far-reaching and largely overlooked impacts of the pandemic on babies, young children and their families. It is vital that this is taken seriously by policy makers with a COVID recovery plan and investment to address growing levels of need and vulnerability.

“We have a longstanding problem in this country with invisible vulnerable children who are not getting the support that they need, and the pandemic has made this situation worse. Therefore, it is vital that any enhanced package of support for ‘Covid recovery’ also includes investment in the universal safety net for our youngest citizens provided by the health visiting service.

“Babies, young children and families need joined up support – to achieve this we need more health visitors who are uniquely placed to reach all families, ideally preventing problems happening in the first place, but also who have a crucial role in identifying babies and young children with developmental delay and unrecognised disabilities that need early intervention and targeted support to achieve their full potential. I hope that this report will provide further impetus for much needed investment to turn the Best Start for Life Vision into a reality.”

Find details of the series of Ofsted reports here: https://www.gov.uk/government/collections/ofsted-education-recovery-series

Go to Education in early years providers: spring 2022 report

Government responds to Petitions Committee’s report on impact of COVID-19 on new parents

Yesterday, the House of Commons Petitions Committee published the Government’s response to the Committee’s first report on the impact of the COVID-19 pandemic on new parents. The response is available here.

The Committee’s report focused on the additional pressures that COVID-19 and the pandemic response have brought for new and expectant parents, and called for: strengthened perinatal mental health services; increased in-person visits by health visitors to new parents; a review of monitoring and enforcement activity relating to employers’ health and safety obligations to new parents; legislation on extended redundancy protections for new and expectant mothers; and a review into the funding and affordability of childcare

The Government’s response states:

“We understand that the pandemic and the pandemic response have involved a significant amount of upheaval for new parents, including through changes or delays to services, and national lockdowns presenting barriers to support and care from friends and relatives. The first 1,001 days from conception to the age of two are critical: they set the foundations for an individual’s cognitive, emotional and physical development through the early years and growing up well. We continue to support giving every child the best start in life, including through building back better from the COVID-19 pandemic. In October 2021, an additional £500 million was announced through the Budget for Start for Life and family help services [this includes £200m for the Supporting Families Programme for children of all ages]. This represents an important step in implementing the vision set out in The Best Start for Life: a Vision for the 1,001 critical days, published by the Early Years Healthy Development Review led by Dame Andrea Leadsom.”

At the iHV, we support the Petitions Committee’s conclusion that, whilst this investment is an important first step and a welcome commitment to the ‘First 1,001 Days’, this does not go far enough. The Committee’s response states:

“We welcome the long-term vision of the Government’s Best Start for Life review, but to date COVID-19 recovery funding aimed at children aged under 2 appears to have been unjustifiably neglected compared to the funding made available for older children. As we emerge from the pandemic, the Government must ensure it invests proportionately in the infrastructure which supports these families.”

The iHV is working closely with the Parent-Infant Foundation and many other leading organisations who are calling on the Government for a fully funded COVID-19 recovery plan for babies, young children and families.

Alison Morton, iHV Executive Director commented:

“There is no denying that the impact of the pandemic on babies, young children and families has been wide ranging, and disproportionately affects those who were already disadvantaged. Whilst the Government’s recent commitment of £300m for the Start for Life Offer is a welcomed step in the right direction, it doesn’t go anywhere near far enough to address the scale of unmet need and intensity of support required.

“Left unaddressed, the burden of vulnerability and early adversity is cumulative and may last a lifetime for some children. But, in a world of seemingly intractable challenges, there is hope – meaningful prevention, early intervention and care promises better health and wellbeing across generations. Inequalities are not inevitable; they are within our gift to change if we have the will and the means to tackle them.

“We therefore join with others in calling for a clear COVID-19 recovery plan for babies, young children and families at the scale of intensity required, and with the investment needed, to put this right. This includes tackling the workforce ‘elephant in the room’. The current workforce shortages in health visiting have been ignored for far too long, and their impact is being felt across the health and social care system and by parents who face the brunt of short-sighted policy making. We need more health visitors, and we need to start rebuilding this vital infrastructure of support for families now.”

We are grateful to the support of more than 700 leading children’s organisations who have supported our call for investment in health visiting. The Parent-Infant Foundation has highlighted three areas where they feel that the Government’s response is insufficient:

The Government is diminishing the impact of the pandemic on our babies
Disparities in recovery funding are inconsistent with Government’s own acknowledgement of the importance of the first 1001 days
More must be done to strengthen our health visiting services.

Read the Parent-Infant Foundation's analysis of the Government's response here

Read the Petitions Committee's news story on the publication of the Government's response

Health visiting in England: The impact of the COVID-19 pandemic

Last week, we were delighted that the international ‘Public Health Nursing’ journal published a paper written by Alison Morton, the iHV’s Executive Director, and Dr Cheryll Adams CBE, Former Executive Director, on the impact of the COVID-19 pandemic in 2020 on families with children under 5 years in England, and the health visiting (HV) service that supports them.

The paper (Health visiting in England: The impact of the COVID-19 pandemic) presents a targeted review of the evidence, with data drawn from national surveys of health visitors and parents, a freedom of information request of employers, published research, and national data. Framework analysis and triangulation, using the Key Elements of an effective health visiting service, were used to categorise the key findings.

The findings from the review indicate that the impacts of the pandemic were wide-ranging and disproportionately affected the most disadvantaged families, increasing demand for health visiting support. The pandemic exacerbated factors that can lead to poorer outcomes for families. Health visitors’ ability to respond was compromised due to national policy decisions to partially stop the service and variations in local implementation including the redeployment of health visitors, pre-existing workforce capacity issues, and the effectiveness of innovations to identify and support vulnerable families.

Key learning from the pandemic response, including the need to prioritise the health visiting service, must be acted upon to reduce ongoing impacts now and ensure that the service is equipped for future emergencies.

Alison Morton commented:

“History has a habit of ‘airbrushing’ the past and it is therefore important that the events of the earliest months of the pandemic are recorded, and the learning is captured to support future responses to similar emergency situations. It was an honour to be able to complete this review in partnership with my predecessor, Dr Cheryll Adams. We are both delighted to see it published in the prestigious international journal, ‘Public Health Nursing’ which is the official journal of the Council of Public Health Nursing Organizations worldwide.

“Babies, young children and families have largely been forgotten in the pandemic response and we hope that this paper, alongside numerous others presenting similar messages, will provide the impetus for much-needed change and investment in the health visiting service in England”

The paper has been published online by Wiley – Public Health Nursing journal as an open access paper – you can read the paper in full here:

https://onlinelibrary.wiley.com/doi/abs/10.1111/phn.13053

iHV responds to House of Lords ‘Children in Crisis’ report

iHV responds to the House of Lords’ Public Services Select Committee report published today into how public services support children and families – Children in crisis: the role of public services in overcoming child vulnerability.

Baroness Armstrong of Hill, Chair of the Select Committee, reports:

“We found a crisis in child vulnerability. Over a million children are now growing up with reduced life chances, too many ending up in care, too many with poor health outcomes… The crisis has grown worse during the pandemic, but it’s been building for many years, partly due to large cuts in early intervention funding.”

This important report is a stark reminder that underinvestment has created worse outcomes for children and higher costs for the taxpayer, as children slip through the gaps between services and do not get the support they need. The report includes clear recommendations for a national strategy for child vulnerability, and also recommends that ‘health visiting’ should be key partners in delivering Family Hub provision.

Responding to the report, Alison Morton, iHV Executive Director, said:

“Today’s hard hitting ‘Children in Crisis’ report lays bare the preventable suffering and misery that has been caused to our nation’s children whose needs have been largely overlooked.

“Cuts have consequences and the poorest children have been hit the hardest. It is time for the Government to prioritise children in their plans to ‘Build Back Better’, particularly babies and young children who have been overlooked the most.

“We call on the Government to make good their pledge to ‘rebuild health visiting’. Health visitors provide a vital infrastructure of support for all families, and a crucial safety-net, identifying vulnerable babies and young children.

“The Government say that they will maintain the Public Health Grant, but this is being maintained at a level that is too low to fund the number of health visitors needed to support all families and identify vulnerable babies and young children. Following years of cuts since 2015, there is now a national shortage of 5,000 health visitors in England and the profession faces its biggest workforce challenge in living memory. As a result, despite health visitors’ best efforts, the service is now so stretched that many families are not getting the support they need, and vulnerable babies and young children are being let down.

“Investment in health visiting is needed to provide the prevention and early intervention support to stop this growing tsunami of children in crisis. This cannot wait any longer – our nation’s children deserve better.”

Read today's report - Children in crisis: the role of public services in overcoming child vulnerability.

iHV speaks about health visiting on BBC Radio Stoke

Alison Morton, Executive Director iHV, joined Lee Thomas at BBC Radio Stoke this morning on an item which is part of a series on the impact of the pandemic on parents – with today’s session on new parents and health visiting.

Alison said:

“It is so sad to hear these stories from those parents who have been seriously let down by a system which is under enormous pressure. And also the health visitors who have worked really, really hard through the pandemic to support thousands and thousands of families, but it hasn’t been enough.”

Alison stated that there are two main drivers for this situation in England: 1) that need has increased; and 2) the capacity of the service to respond has been stretched to the limit – with parents bearing the brunt of this.

“As many of the parents stated, a lot of the health visiting services shifted to non-face-to-face, using video and telephone, but it is not the same as seeing someone face-to-face. The root of this can be traced to the beginning of the pandemic when the Government categorised health visiting as a partial stop service – there was a failure to recognise the health visitor’s vital role and the support that it offers to parents; just being alongside parents.”

She also said that the current ‘sticking plasters are not good enough’ and we need a national plan to put it right for children now.

The news item on parents and the pandemic starts at 1:09:13 into the programme with parents providing their experiences, and Alison joins at 1:11:41 with the item ending at 1:19:33

Go to BBC Radio Stoke programme

Fab videos to showcase great HV work

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:

Find out more at LGA videos - Healthy Child Programme during COVID-19

iHV launches 8th Annual Report

The Institute of Health Visiting (iHV) is delighted to announce the launch of its eighth Annual Report.

Launched at the iHV annual Leadership conference on 1 December 2020, the report details the Institute’s developments, partnerships and projects over the past 12 months, plus the preliminary findings from our latest annual survey.

After the initial disappointment of having to postpone so many of our plans for 2020, #TeamiHV quickly embraced the challenges of working online to not only deliver our conferences and PIMH Forums on a virtual platform but our training as well, and this has been very enthusiastically received.

2020 has been a year like none before for health visiting, as it faced the challenges of adapting to a world forced into “lockdown”. The challenges of COVID-19 have been felt both by the Institute and in practice, bringing with them much learning. Our first concern is always the families we support, whom we know this year did not receive either adequate or, in some cases, any support during a crucial time.

Whilst much of the world’s attention was focused on reducing the transmission of the virus and treating acutely ill patients (mostly adults), it was clear that the needs of children and families were increasing, yet they were largely overlooked by policy makers. At the iHV, we have been concerned from the outset about the wider impacts of the pandemic and have raised concerns about the vulnerability of babies and young children who are at home, hidden from society and some living with significant adversity and abuse.

Download eighth iHV Annual Report

Spotlighting the vital “safety net” that health visitors have provided for babies and young children during the current pandemic

The Institute of Health Visiting (iHV) has published “Making History: health visiting during COVID-19”, a collection of case studies which presents a window into the working lives of health visitors and families navigating the ups and downs of the COVID-19 pandemic.

In these unprecedented times, the world “locked down”. Yet life continued, babies kept being born and the normal struggles of parenthood became amplified for many.

Whilst some families enjoyed the relative peace of an enforced slower pace of life; most families were negatively impacted by lockdown and home was not a safe place for some, with rates of domestic violence and abuse, mental health problems and safeguarding concerns quickly becoming a source of concern.

The case studies, family stories and creative pieces contained within “Making History: Health visiting during COVID-19” capture the pace and scale of change as health visiting services adapted to working during “lockdown”.

Alison Morton, Director of Policy at the Institute of Health Visiting, commented:

“It has taken a global public health pandemic to shine a spotlight on the importance of the health visiting service.

“Parents reached out to health visitors for support as many other sources of support were no longer available. Health visitors are Specialist Community Public Health Nurses providing a vital “safety net” for babies, young children and their families whose needs can easily be hidden from sight. Their specialist public health skills, supporting babies, young children and their families during the biggest public health emergency in living memory, have been needed more than ever.”

Health visitors have risen to this challenge with professionalism and autonomy, flexing and developing innovative service “workarounds” to ensure that families receive the best possible support. Different areas have responded in different ways, many introducing “virtual contacts” instead of face-to-face, as well as rapidly responding to urgent needs to support families using Personal Protective Equipment.

Councillor Ian Hudspeth, Chairman of the Local Government Association Community Wellbeing Board, commented:

“Councils are incredibly proud of how their public health workforce has responded over the last 6 months. This report is testimony to the commitment and resilience of health visitors and illustrates the pivotal role they play in ensuring children and families get the support they need in challenging times.

“In the upcoming Spending Review, we are asking the Government to reverse the £700 million of public health reductions, to enable councils to strengthen this workforce and ensure we can continue to support families when they need us most.”

Alison Morton concluded:

“We need to learn from COVID-19 and the experiences of families and health visitors to ensure that the health visiting service is strengthened and fit to face the challenges that lie ahead as we adapt to living with the virus for the foreseeable future. The challenges that we face are not insurmountable – individually and collectively we have the ability to put things right. But this requires bold action to make the difference – there is no time to waste, the time to act is now.”

Read iHV's Making History: health visiting during COVID-19

Our recommendations for restoration of the health visiting service are:

Health visiting services should be reinstated (where they have not been) as a matter of urgency as a vital support and safety-net for children, with appropriate measures put in place, including the use of PPE, to reduce the spread of the virus.
Health visiting services must be fully prepared for any future waves of COVID-19. NHS England should revise the Community Prioritisation Plan (for phase one pandemic management) and develop clear messages on the importance of continuation of the service to ensure the needs of children are prioritised. This should include removing wording on the redeployment of health visitors.
A clear workforce plan is needed to ensure that the service has sufficient surge capacity to manage the backlog of missed appointments, as well as demand for support due to the secondary impacts of the pandemic.
An evaluation of the use of virtual, non-face-to-face service delivery methods is urgently needed to determine their effectiveness for identification of vulnerabilities and risks, impact on child and family outcomes and reducing inequalities to inform future digital change.
A cross-government strategy is needed to reduce inequalities and “level-up” our society – this will require investment to strengthen the health visiting service which plays a crucial role in the early identification and support of the most disadvantaged families.
The impact of working during the COVID-19 pandemic on staff wellbeing cannot be underestimated – a proactive plan is needed to ensure staff have the right support during the restoration of services and to create high quality workplaces for all staff in the future