Health visitors raise the alarm as more families struggle with poverty and poor health

The Institute of Health Visiting (iHV) publishes its findings from the largest UK survey of frontline health visitors working with families with babies and young children across the UK – “State of Health Visiting, UK Survey Report: Millions supported as others miss out”.

It’s deeply shocking that 93% of health visitors reported an increase in the number of families affected by poverty in the last 12 months. Poverty was the cause of greatest concern to health visitors. They visit the homes that families are struggling to heat and witness the impossible choices that parents are forced to make about feeding their children or paying the bus fare to attend vital health appointments. These struggles are often hidden behind front doors and invisible to other services until the situation reaches crisis point. Alongside an increase in poverty affecting families over the last 12 months:

89% of health visitors reported an increase in the use of food banks
78% an increase in perinatal mental illness
69% an increase in domestic abuse
63% an increase in homelessness and asylum seekers
50% an increase in families skipping meals as a result of the cost-of-living crisis.

Only 3% of health visitors surveyed reported that families had not been impacted by the cost-of-living crisis. Some reported that poverty was so widespread that it had become the norm.

In our survey, health visitors also raised concerns about the wider impacts of poverty and increased parental struggle on children’s health, development and safety. The Government’s own data show that more children in England are falling behind with their development and health inequalities are widening. Worryingly, the situation is getting worse and showing no signs of recovery.

The good news is that health visitors saw millions of families last year, reaching significantly more babies and young children than any other health service or early years agency. However, despite health visitors’ best efforts, they are not able to meet the scale of rising need. Too many babies and young children are not receiving packages of support to improve their health and development when they need it, due to ongoing cuts to the health visitor workforce:

There is a national shortage of around 5,000 health visitors in England and families face a postcode lottery of support.
79% of health visitors said that the health visiting service lacked capacity to offer a package of support to all children with identified needs.
Only 45% of health visitors were “confident” or “very confident” that their service was able to meet the needs of vulnerable babies and children when a need is identified.
80% of health visitors said that other services were also stretched and lacked capacity to pick up onward referrals for children with additional needs. Thresholds for children’s social care support had increased and other services had long waiting lists.

Alison Morton, CEO at the Institute of Health Visiting, says,

“Consistently, health visitors have told us that parenting has become much harder for many families over the last 12 months. Health visitors are in a privileged position, they see firsthand the struggles that families with babies and young children are facing, often hidden behind front doors and invisible to other services. Sadly, despite policy promises, more and more children are not getting the “best start in life”. And the situation is getting worse with more children falling behind with their development and widening health inequalities. As babies can’t speak for themselves, health visitors provide a vital “voice” for our youngest citizens and an important warning signal for policymakers who are prepared to listen. It doesn’t have to be this way, change is possible.”

We publish at the start of a new year, with political and economic uncertainty, but also with hope as all political parties consider their plans to improve the health of our nation ahead of a general election expected this year. Our survey findings highlight the incredible potential and desire within the health visiting profession to support a brighter future for our nation’s children. But we cannot ignore the fact that the health visiting workforce is under significant pressure with unacceptable levels of work-related stress, as health visitors manage enormous caseloads, and escalating levels of need and vulnerability. We urgently need more health visitors.

Alison concludes:

“Our survey findings present a clear imperative to act. If we get the early years right, we can avoid so much harm later in life. The cuts to health visiting in England over the last 8 years have been a false economy. When sufficiently resourced, health visitors can take pressure off busy A&E departments and GPs, providing support for families in the heart of the community. The costs to rebuild the health visiting service in England are small compared to the spiralling costs of NHS treatment, child maltreatment and cumulative costs across the life course. Investing in our children’s health is not only the right thing to do, it also makes sound economic sense.”

Read the full report “State of Health Visiting, UK Survey Report: Millions supported as others miss out”

To cite this report, please use the link to the pdf here: https://bit.ly/48W6TcE

New report – Calling Time on child poverty: how Wales can do better

This week, the Equality and Social Justice Committee of the Senedd has published the report of its inquiry into child poverty – Calling Time on child poverty: how Wales can do better. The inquiry was prompted by the high levels of child poverty in Wales and concerns about the Welsh Government’s draft strategy to eradicate it.

The report provides stark data and challenge, asking:

“Across the United Kingdom 4.2 million children under 18 live in poverty… Why do we tolerate that when we are part of the 6th richest economy in the world?”

The latest figures show 28% of all children in Wales are living in relative income poverty. That is 8 children in a class of 30. Most child health outcomes are socially driven, with the poorest children consistently and disproportionately disadvantaged compared to their more affluent peers. The Committee’s report recommends a root and branch review of the Welsh Government’s approach as it finalises its new child poverty strategy.

At the iHV, we support the Senedd’s Equality and Social Justice Committee call for a dedicated Minister for Babies, Children and Young People to be appointed to provide a more coherent response to the scourge of child poverty.

Under the current Welsh Government arrangements, the Minister for Social Justice has responsibility for tackling child poverty, while the Deputy Minister for Social Services and the Deputy Minister for Mental Health and Wellbeing lead on children’s well-being issues, and the Minister for Education retains responsibility for their educational attainment.

The Committee is calling for one Minister to be accountable for the wellbeing and happiness of babies, children and young people. This role should incorporate overall responsibility for tackling child poverty and implementing children’s rights with other key areas such as childcare, education and supporting families.

The report is also recommending that the Welsh Government set ambitious and realistic interim and longer-term targets for reducing child poverty, learning from the approaches taken in other countries such as Scotland, Norway and New Zealand.

Jenny Rathbone, MS Chair of the Equality and Social Justice Committee, said:

“Our central message is that the Welsh Government needs to follow the evidence and prioritise those policies which make the maximum contribution to tackling child poverty. This may involve difficult decisions and trade-offs. But it must embed children’s rights in policy and in practice.

“The Government needs to overcome its aversion to setting targets. The evidence from Scotland and New Zealand is clear: targets work. Alongside other measures and milestones, they set the direction of travel, and keep track of progress.

“Finally, appointing a Minister for Babies, Children and Young People would send the clearest signal that Wales is serious about giving every child the best start in life.”

Read the full report here

Health visitor survey finds that more babies and young children are missing out on the government’s promise of the ‘best start in life’

The Institute of Health Visiting (iHV) publishes the findings from the largest UK survey of frontline health visitors working with families across the United Kingdom.

Our survey findings paint a bleak picture with health visitors seeing first-hand the realities that families with babies and young children in the UK are facing. Health visitors are reporting epidemic levels of poverty, with more parents struggling under the weight of the cost-of-living crisis that is forcing them to turn to food banks to feed their children. Alongside this, more parents are living with mental health problems, domestic abuse and adversity, that pose risks to the health and wellbeing of babies and young children.

Health visitors are witnessing the impacts of stress associated with poverty on children’s safety, health and development. At the same time, there are insufficient health visitors to meet the scale of rising need. This is being felt most acutely in England, as health visitors are battling to deliver a service following a loss of almost 40% of health visitors since 2015. Consequently, despite health visitors’ best efforts, many families are not receiving the support that they need, and this is being intensified by a lack of capacity in other health and social care services who are also experiencing extreme pressures.

Alison Morton, Executive Director at the Institute of Health Visiting, says,

“Through their universal reach, health visitors have a privileged and unique view into the lives of babies, young children and their parents/ carers across the UK. Health visitors’ experiences presented in this report provide an important ‘early warning signal’ of the most pressing threats and challenges to the health and wellbeing of our youngest citizens which are often hidden behind front doors and invisible to other services.

“The findings also paint a deteriorating picture of a health visiting workforce under immense pressure as practitioners struggle to meet the scale of rising need. Families are facing the brunt of these challenges with a widening postcode lottery of health visiting support across the UK.”

We publish at a time of ongoing uncertainty with political and economic instability, and ever-increasing health inequalities that will get worse if not addressed. The whole of the health and care system is also struggling to rebuild in the wake of the pandemic. As health visitors often work alone, or in small teams in families’ homes, their work is often hidden and it’s easy to overlook how important it is. The NHS backlogs regularly hit the headlines, but they are only one part of the legacy left by the pandemic on the healthcare system; less high-profile backlogs of care and unmet need in health visiting services have been overlooked within a ‘baby blind spot’ in national policy which will leave equally serious challenges for both mental and physical health for babies, children and families across the UK, now and in years to come.

Alison concludes:

“Because the first years of life are so important for lifelong health, wellbeing and success, ignoring this tsunami of unmet need being experienced by our youngest citizens risks undermining the life chances of so many children.

“It is not too late to change direction and pursue reforms, but the situation is serious. There is now unequivocal evidence that the current rate of health visitor workforce attrition, and insufficient training places to plug the forecasted gaps, is not sustainable and will jeopardise the delivery of all UK Governments’ child health programmes.

“In England, the Government categorised health visiting as one of six priority services in its Start for Life Vision for the first 1001 days. However, this commitment is at risk without investment and a plan to rebuild the health visitor workforce.”

Rising needs and widening inequalities – child safety, health and development: the problem, some key facts and stats:

91% of health visitors reported an increase in poverty affecting families over the past 12 months
91% reported an increase in families needing foodbanks
83% reported an increase in perinatal mental illness
75% reported an increase in domestic abuse.

Health visitors have witnessed first-hand the impact on babies and young children’s safety, health and development:

84% of health visitors reported an increase in children with speech, language and communication delay
76% an increase in child behaviour problems
60% of health visitors reported further increases in child safeguarding over the last 12 months (building on significant increases reported last year).

Health visitors in England also raised serious concerns that national data mask increases in child safeguarding, as:

Children living with significant risk and vulnerability are not detected as services are cut, and
Social workers’ caseloads are capped to a maximum – growing numbers of children living with significant risk and vulnerability now fall below higher thresholds.

Only 7% of health visitors in the UK felt confident that all families would be able to access the support they needed when a problem was identified. 86% reported that there was not enough capacity in other services to pick up referrals for support/ treatment

Our main policy recommendations:

Prioritise the first 1001 days of life – a shared cross-government ambition and strategy for the first 1001 days is needed to improve health outcomes and reduce inequalities for babies, young children and families. This needs to be prioritised by the Treasury and seen as the smartest of all investments in our nation’s future, rather than as a cost.
A shift towards prevention and early intervention is needed to support all people to lead healthy and fulfilling lives by addressing the key public health priorities that pose the greatest threats to our nation’s health, thereby preventing debilitating and costly ill health in later life.
Equity of access to support is needed for all babies, children and families across the UK and an end to the current postcode lottery.
System’s thinking – the benefits of an effective health visiting service accrue to numerous government departments and across a person’s lifetime. Complex system’s principles need to be applied across all aspects of health and care delivery, including workforce planning, funding and the development of measures that capture health visitor’s input and impact across the system.
Integrated clinical care pathways with significant ‘front-loaded’ investment in prevention and early intervention are needed across health visiting, school nursing, midwifery, social care, General Practice, and early years, to ensure:

All babies, children and families are supported to reduce inequalities in key priority areas
All children at risk of poor outcomes are identified early
A continuum of support for a continuum of need is provided to achieve shared goals for key public health priorities for babies, children and families.

Strengthening the health visiting service requires a clear plan focused on the following three areas:

Funding – All areas need sufficient funding to deliver the full national specification for the health visiting service and preventative public health programme for children
Workforce – A demand-driven, well-resourced national workforce strategy is needed to increase the number of health visitors to address current and forecasted losses, and improve retention, job satisfaction and career progression for experienced staff
Quality – National government must do more to:
- support local authorities with resources to provide health visiting services at a level that delivers everything that government and NICE guidance expects of them, and that families need
- hold local authorities to account when services are not meeting national guidelines
- support the ongoing research, development and sharing of evidence-driven models of best practice based on proportionate universalism.

Read the full report here

iHV supports call for next UK Government to take urgent action on poverty

The iHV welcomes and supports the call from the Royal College of Paediatrics and Child Health (RCPCH) and Children Poverty Action Group (CPAG) on the next UK Government to take urgent action on poverty to ensure a healthier future for the UK’s infants, children and young people.

Poverty and low income is seriously affecting the health of UK children according to paediatricians – and any new Government must tackle health inequalities or risk storing up health problems for future generations. That’s according to a new report from the Royal College of Paediatrics and Child Health (RCPCH) and Child Poverty Action Group (CPAG) launched today.

The report “Poverty and child health: views from the frontline” is based on a survey of more than 250 paediatricians across the country, whose comments provide an insight into the grave reality of life for the millions of UK children living in poverty.

Latest figures show that 30% (4 million) children in the UK live in poverty – with projections suggesting this could rise to 5 million by the end of the decade.

Dr Cheryll Adams CBE, executive director, iHV, commented:

“The iHV welcomes and supports the call from the Royal College of Paediatrics and Child Health (RCPCH) and Children Poverty Action Group (CPAG) on the next UK Government to take urgent action on poverty to ensure a healthier future for the UK’s infants, children and young people.

We particularly welcome the call to reverse public health cuts to ensure universal early years services, including health visiting and school nursing, are prioritised and supported financially, with additional targeted help for children and families experiencing poverty. The recent reduction in health visitor numbers impacts the vital support that babies, young children and families need at such a critical time in their lives – we want to ensure that every child has the best start in life.”

The report looks at a number of areas including food insecurity, poor housing and worry, stress and stigma – and their effect on the health of children. It reveals that:

More than two-thirds of paediatricians surveyed said poverty and low income contribute ‘very much’ to the ill health of children they work with
Housing problems or homelessness were a concern for two thirds of respondents.
More than 60% said food insecurity contributed to the ill health amongst children they treat 3
40% had difficulty discharging a child in the last 6 months because of concerns about housing or food insecurity
More than 50% of respondents said that financial stress and worry contribute ‘very much’ to the ill health of children they work with

The RCPCH and CPAG are calling on whoever forms the next Government to tackle poverty urgently through:

The restoration of binding national targets to reduce child poverty, backed by a national child poverty strategy.
The adoption of a ‘child health in all policies’ approach to decision making and policy development, with Her Majesty’s Treasury disclosing information about the impact of the Chancellor’s annual budget statement on child poverty and inequality.
The reversal of public health cuts to ensure universal early years services, including health visiting and school nursing, are prioritised and supported financially, with additional targeted help for children and families experiencing poverty.
The reversal of cuts to universal credit which will leave the majority of families claiming this benefit worse off.

Download full report (PDF, 1.1 MB) or read summary here.