Health visitors across the UK have expressed their widespread disappointment at the Government’s dismissive response to a recent petition calling for reinvestment in health visiting. The petition was set up by health visitors in Hampshire who were concerned that the proposed cuts to their service, and many other local authorities in England, would knowingly cause harm to babies and young children, and leave families without the support they need.

The Government’s response to this petition has been labelled a ‘whitewash’ by many as it fails to take these concerns seriously, stating: “Local authorities are best placed to make decisions for their communities… Local delivery models vary, as services are tailored to meet local need… We do not advocate a specific health visitor staffing number or case load. This is because it should be led by health needs of a population.”

Lesley Tarling, the health visitor in Hampshire who set up the petition, says:

“I’d like to thank the Government for their response to our petition. However, it is disappointing that the core question in our petition remains unanswered. Funding cuts have inevitable consequences, health provision to the young will be irreparably affected. Health issues will be missed, and Adverse Childhood Experiences accentuated”.

Has need gone down? Do some areas not need a robust health visiting service? On the contrary, the evidence is clear that vulnerable babies, young children and families live in every postcode in the county, and many of the challenges they face are not socially correlated. With widening inequalities in England, a poor state of child health, more families tipped into vulnerability due to the pandemic, and a backlog of children not seen face-to-face, health visitors are needed more than ever to ensure that babies and young children at risk of poor outcomes are identified, and that families are supported at the earliest opportunity.

It will be a while before we know the full impact of the pandemic, what is clear is that need has definitely not gone down. Many health visitors are reporting that they are concerned that they are only reaching the “tip of the iceberg”, with research highlighting increased demand across the breadth of health and social needs.

Health visiting entered the pandemic in an already depleted state following a 31% reduction in health visitors in England since 2015, with more local authorities planning further cuts due to budget deficits. 80% of health visitors now manage caseloads above the recommended number of 250 children per health visitor (almost one-third have more than double this amount, and 12% have over 700 children). As a result, families face a postcode lottery of support – it is clearly impossible for a single health visitor to provide the personalised care that parents want, and that the Government recognises as central to effective outcomes. With such unmanageable caseloads, no amount of delegation or ‘digital light touch offer’ can detract from the key governance issue that a single health visitor will be responsible for overseeing, planning, reviewing and supervising the care of such large numbers of children.

Should local areas decide? Whilst there are some excellent examples of effective services, the petition response ignores the current “Wild West” of health visiting which cannot be ignored. The Government’s own Early Years’ review reported that families are being let down by poor quality services in some areas with findings published in March highlighting: “workload pressures… meant it was hard for dedicated professionals and volunteers to support families in the way they wanted to and, sadly, the Review also heard examples of instances where families felt let down by the services they received”. 

What would babies and young children say? They are citizens with their own needs and rights that are easily overlooked without the universal safety net that a robust health visiting service provides.  Sadly, 285 children were killed or seriously harmed in the first 6 months of lockdown; of these, 35.8% were babies under 1-year of age. Babies under the age of one also remain at the highest risk of homicide compared to any other age group. Our most vulnerable members of society cannot ask for help, they rely on others to advocate for them. Whilst many parents can advocate on behalf of their baby or young child, sadly in some instances, parents cannot care for their child and lack the agency to reach out for help when needed. It is therefore vital that an effective, statutory, universal health visiting service is provided in all areas – this cannot be left to chance.

When we recently challenged these serious incident and child death figures, we were offered the platitude that although the figure had increased this year, it was not extraordinary as it had been almost as high in 2018/19!!! Does this make it acceptable? Each one of these children represents another “Baby P” or “Victoria Climbié” – they have paid the ultimate price and been let down the most. We need to do better, not worse. Yet, the health visiting service intended to identify and support vulnerable babies and young children faces ongoing cuts, a shift to non face-to-face contacts, and outcomes reduced to ‘bean counting’.

We cannot say we didn’t know – the Government’s lack of action sends a powerful message that the current state of affairs is acceptable.

Look beyond the misleading and superficial process outcome data: The Government’s petition response states that:

“most recent data available on health visitor service delivery in England shows that a high proportion of infants received mandated health reviews in 2019/20:

  • New birth visits completed: 97.5%
  • Proportion of infants receiving a 6 to 8 – week review: 85.1%
  • Proportion of children receiving a 12 – month review: 77.0%
  • Proportion of children receiving a 2 -2 ½ review: 78.6%.”

It is important that we keep the needs of the child at the centre and are not misled by this ‘whitewash’ of process outcome measures which overlook important quality metrics. What this data does not show:

  • A postcode lottery of health visiting support with some families reporting that they haven’t seen a health visitor face-to-face for over a year.
  • Many of these reviews are not completed by qualified health visitors now. In a recent survey by the Institute of Health Visiting, only 17% of 1-year reviews, and 10% of 2-year reviews, were completed by a qualified health visitor.
  • To cut costs, some areas are now completing these important universal assessments with a postal or telephone contact despite evidence warning that this practice is unsafe and introduces unacceptable risks – it ticks the box, but misses the point: Needs change over time – it is therefore imperative that ALL 4 mandated reviews that children receive between birth and 2.5 years are completed face-to-face (we need to get this right, it is such a minimal ask). It is clearly impossible to complete an accurate holistic assessment of a baby or young child without physically seeing them, the subject of the assessment. The lack of national standards for these reviews and the Government’s knowing acceptance of the dangers inherent in this ‘local flex’ is causing harm; vulnerable children and serious health conditions will continue to be missed unless addressed. Virtual contacts have a place in a modern healthcare system, but they should not be used for universal reviews and should only be used when it is safe to do so and they enhance quality of care.
  • Whether the contacts actually made a difference: The universal contacts are a  gateway into health visiting support and will only be effective if the service has sufficient capacity to act on identified needs and provide the intensity and quality of support needed to make a difference.

Investment in babies and young children and preventative public health: The petition response states that the public health grant to local authorities in England will increase from £3.279 billion in 2020/21 to £3.324 billion in 2021/22, an increase of 1% in cash terms. However, this represents a cut in real terms. Public health grant allocations have fallen in real terms from £4.2 billion in 2015–16.  On a per head basis that equates to a 24% cut since initial allocations were made in 2015–16 (Health Foundation analysis).

At a minimum, the Government should restore the grant to 2015/16 levels by investing an extra £1 billion a year and then ensure that the grant keeps pace with growth in NHS England’s spend and covers the costs of implementing the Early Years’ review recommendations in full. We have estimated that in order to rebuild the service and ensure that all families receive the support they need, an additional 5,000 health visitors are needed in England.

This situation is reversible but needs political will. Children’s needs should now be prioritised in the manner that those of adults were during the pandemic. The proposed cuts should not be allowed, earlier reductions in children’s services should be reversed, and the welfare of babies, children and young people should be put at the centre of all policies for civil society.

We emphatically do not suggest that the problems described are intended outcomes, but without any changes, many leading stakeholders agree that state harm will come to be the phrase used to describe them.

Read the full response to the petition here: https://petition.parliament.uk/petitions/589522

Specialist Health Visitors working with families experiencing homelessness have created the Medact / QNI Homeless Health Programme petition ‘Healthy Housing is a Human Right’ asking for an immediate Government inquiry into the plight of homeless families currently in temporary accommodation and automatic health and education rights for children.

This call is supported by many other agencies including iHV, Pathway, Shared Health Foundation, LNNM, RCN and CPHVA.

Will you join us in calling for the Government to:

  • Conduct an immediate Government Inquiry into the plight of families experiencing homelessness in temporary accommodation
  • Guarantee that individuals and families who are destitute are always placed in accommodation, no matter their immigration status
  • Ensure children who are experiencing homelessness are given automatic health and education rights
  • Provide priority access to NHS services for children experiencing homelessness, ensuring that a lack of ability to provide address ID is never a barrier to services
  • Increase the number of specialist Health Visitors and School Nurses to meet the needs of the increasing number of families experiencing homelessness
  • Recognise homelessness as an Adverse Childhood Experience (ACE)

Please could you support this campaign by signing the petition here.

The Government has given their response to the Petitions Committee’s landmark report on the impact of COVID-19 on maternity and parental leave.

The report was the result of an extensive inquiry following an e-petition calling for the Government to extend maternity leave by 3 months with pay in light of COVID-19 which received over 226,000 signatures, and to which Dr Cheryll Adams contributed some evidence via Zoom in May earlier this year (see iHV at Petition Select Committee).

See also iHV responds to Petitions Committee report: impact of COVID-19 on maternity and parental leave

Dr Cheryll Adams commented on today’s news on the Government Response:

“The Government Response to the report by the Petitions Committee’s recommendations on the impact of COVID-19 on parental leave is a disappointing response by government to such powerful lobbying by parents. So many new families have struggled during the past 6 months and more acknowledgement of that, in the form of positive responses to at least some of the recommendations, would have meant that they felt more valued in their essential role of bringing up the next generation.”

 

The Petitions Committee has today launched its landmark report calling on the Government to extend parental leave and pay for all new parents affected by COVID-19.

More than 226,000 people have signed an e-petition calling for the Government to extend maternity leave by 3 months with pay in light of COVID-19. The committee received over 69,000 responses with people sharing their experiences and views on the Government’s response and on the actions they think need to be taken.

But the Government’s response to this petition to date has been to turn down petitioners’ requests for more time. The Committee has heard from new parents who have found that their jobs are at risk as they are unable to find childcare, from parents whose mental health has been severely affected, and from parents who are desperate for help and support. In addition, Dr Cheryll Adams appeared before the House of Commons Petitions Committee in May to talk about the petition – she contributed some evidence and raised the profile of the work of health visitors during COVID-19 – see news story here.

Dr Cheryll Adams CBE, Executive Director, iHV, commented:

“This enquiry has demonstrated government and democracy at its best, with the views of the population, in this case new parents, being truly listened to. Young families have received little attention during the response to the COVID–19 pandemic but the Institute has reported that their needs, as a result of lockdown, could form a secondary pandemic if not addressed quickly.

“As families start to surface again, we are now hearing evidence of the impact of the past three months in lockdown on families, with an increased incidence of safeguarding issues (more domestic violence), more infants going into care. Health visitors are also reporting an explosion of mental health issues, especially for our most vulnerable families including those who have fallen into poverty due to job losses, or who may have had children with special needs or prematurity.  Many others are worrying about their return to work as evidenced by the enquiry. The loss of easy access to the normal support services, and to opportunities to maintain their social and emotional wellbeing through meeting with family and friends has been profound.

“We recommend that the Government listens to the overwhelming evidence gathered from parents and experts in the early years by this enquiry committee. It must act now to provide additional support, especially to those needing to return to work in the next few weeks/months, but also respond to the clear evidence that this stage of everyone’s life trajectory needs to be taken much more seriously by the Government. Ultimately all the evidence is clear, doing so will lead to many future financial and social benefits for the country as a whole.

“An urgent first step is to do a workforce review of the health visiting service, provide new funding to replace the huge numbers of health visiting posts which have been allowed to be lost since 2015, and address the inconsistencies in the health visiting services that parents can access up and down England. The Institute has already published its own Vision for how this should be done.”

 

 

The report finds that there are many more areas where the Government needs to consider taking urgent action, including access to free dental treatment for new mothers, access to rapid COVID-19 testing for parents with babies in neonatal care, and the extension of protections for women against losing their jobs as a result of being pregnant or a new parent.

 

 

Key findings and recommendations made in the report include:

  •  New parents have missed out on crucial support, the lack of which could have a huge impact on their mental health and that of their children, with resulting impacts on the NHS and the UK economy
  • The Government should extend parental leave and pay for all new parents affected by the pandemic. This includes maternity leave, shared parental leave and adoption leave
  • The Government should publish clear new guidance for employees and employers on supporting pregnant employees and those returning from parental leave that explains clearly their options and responsibilities
  • The Government should consider extending the period in which pregnant women and new parents may bring claims before the employment tribunal to 6 months from dismissal in light of current challenges posed by Covid-19
  • Free dental care is an important benefit that most pregnant and new mothers have been unable to access as the result of the pandemic. The Government should extend maternity dentist provision for new and expectant mothers affected by the pandemic for at least six months
  • The Government should review the provision of health visitor services in light of Covid-19 and consider funding increased numbers of health visitors and other allied professionals, to ensure that vulnerable families are identified and given the support they need
  • The Committee strongly urges the Government to follow the science and stay alert to how the Government supports new parents so that the effects of the pandemic do not continue to impact families for years to come

 

Today, Dr Cheryll Adams CBE appeared before the House of Commons Petitions Committee to talk about the petition “Extend maternity leave by 3 months with pay in light of COVID-19“. She contributed some evidence and raised  the profile of the work of health visitors during COVID-19.

The meeting took place via Zoom and was shown on Parliament TV.

 

 

 

‘The Institute of Health Visiting supports the petition to keep the voice of nursing in the Department of Health.

Nursing is the largest professional health group, so to lose its voice in the Department of Health can only be counter-productive to progress in health visiting, nursing and midwifery, and in turn to the health of the population.

As an organisation we have been able to achieve so much good due the support of those in the DH nursing directorate, we hence really fear the consequences of losing the direct nursing voice in policy.

Please support this petition for a parliamentary debate to reconsider this decision.’

Dr Cheryll Adams CBE –  Please sign and share on behalf of your profession and those you serve.