Independent Child Safeguarding Practice Review Panel’s annual report 2023 to 2024

Today, The Independent Child Safeguarding Review Panel has published its annual report which consolidates the learning from serious incidents where children have died or suffered serious harm. Each case represents a child whose life was cut short or seriously harmed. Many were abused or neglected, inside and outside their families – the learning contained in this report cannot change the past, but it has the potential to change the future.

The findings and recommendations will be relevant for all health visiting practitioners, managers and system leaders – they help us to make sense of what happened to these children and consider how we can improve the ways that we work to protect children in the future.

The report identifies national patterns in practice through analysis of 330 serious safeguarding incidents (Serious Incident Notifications (SINs)) which occurred between 1 April 2023 and 31 March 2024, and 82 Local Child Safeguarding Practice Reviews considered by the Panel in this same period.

Importantly, careful analysis of multi-agency practice when things have gone so catastrophically wrong in children’s lives can shed light on the experiences of the broader group of children who need safeguarding. The analysis also highlights good practice and recognises that very many practitioners bring enormous skill and imagination to safeguard children. It also demonstrates the strains and stressors being faced by families and across the health and care sector, with diminished capacity in services that can impede our collective ability to protect children.

In addition to key data about the children and their families who are the focus of reviews, the report spotlights three themes:

Safeguarding children with mental health needs
Safeguarding pre-school children with parents with mental health needs
Extrafamilial harm

Key findings:

In 2023 to 2024 there was an 18% reduction in the number of notifications, particularly those relating to serious harm. The drivers for this reduction need to be interrogated further, at both a national and a local level.

During the review period, almost half of the incidents were due to the death of a child, and almost half were due to serious harm. The age distribution of children was very similar to previous years, with under 1s still experiencing the most harm, representing over a third of all incidents.

Notably, in a quarter of incidents, at least one parent or relevant adult was reported to have either a physical, mental health-related, learning or developmental disability, a substantial increase from the previous year. In just over half of the incidents, at least one parent was reported to have one or more mental health conditions, and in 43% of reviews, there was a parent with an addiction to or misuse of alcohol and/or substances.

Of particular relevance to health visiting, the spotlight theme on “Safeguarding pre-school children with parents with mental health needs” reported the following findings:

Parental mental health was often overlooked as a potential risk factor when considering parents’ capacity to care for their children.
There tended to be an over-focus on visible contextual factors, such as home conditions, with less consideration of mental health, despite indicators of both historical and current deteriorating mental health.
Findings also identified a lack of effective communication between and within statutory and non-statutory services, particularly adult services and child services.
Reviews and literature identified a critical absence of support for parents with mental health needs or conditions who have children between the ages of 1 and 5, with research predominantly focusing on pre-natal and perinatal mental health.

Linked to this, some reviews identified children not being brought to their health appointments which might, in turn, have been associated with the parents’ mental health and other challenges they were facing at that time. Critically and sensitively exploring the reasons for non-attendance might have assisted in better engagement by understanding and unblocking any manageable barriers for parents.

These issues highlight the challenges for practitioners and agencies when trying to successfully engage parents in discussing the impact of these issues. Mental health needs can fluctuate between periods of stability and instability, improvement and deterioration. This, along with the presence of other stressors or vulnerabilities, means practitioners and services may need to be as flexible and accommodating as possible when working with parents in these circumstances.

Commenting on the Report, Hilda Beauchamp, iHV Mental Health Lead, said:

“The sobering spotlight on ‘Safeguarding pre-school children with parents with mental health needs’ flags the recurring need for professional curiosity, better inter-agency communication, and greater consideration of the complex intersecting factors that impact parental mental health. Some good practice by health visitors in identifying and managing risk to babies and children related to parental mental health is noted, but this report leaves us in no doubt that more can be done to protect our most vulnerable little ones.”

The Report contains key learning points for direct practice and learning for strategic leaders and managers – as well as reflective questions to assist practitioners, managers and leaders in considering practice in their area.

Read the report here

Families living in poverty struggling to access early childhood services, new report finds

A new report by NSPCC and the UK Committee for UNICEF (UNICEF UK), published this week, sets out how families experiencing poverty face barriers to accessing early childhood services at every level in the UK.

The report, “Opening Doors: access to early childhood services for families impacted by poverty in the UK”, draws from an evidence review and new research with parents and carers who are experiencing poverty and raising children aged under-5, as well as early childhood professionals.

Poverty can have a negative impact on a young child’s development, increasing their likelihood of ill health, poor mental health, and putting them at a disadvantage before they start school. In the UK, more than one in three (36%) children in families where the youngest child is under five are living in poverty.

However, inequalities are not inevitable. Access to high quality early childhood services, such as maternity, health visiting and integrated support in children’s centres or family hubs can significantly reduce these inequalities and provide a lifeline for families on low incomes. Despite this evidence, the report provides new data on a sector under enormous pressure, with early childhood professionals often working in unsupportive environments, and a significant shortage of midwives and health visitors.

The report found that this shortage is resulting in a lack of outreach, rushed appointments, and a different professional at each contact, which can damage relationships with parents and leave them unable to discuss sensitive issues.

One mother said: “It’s really difficult when they change your midwives all the time and change your health visitor, and they change where you’re going for appointments.”

The NSPCC and UNICEF UK believe that the upcoming UK-wide Child Poverty Strategy and the 10-Year Health Plan in England offer crucial opportunities for the UK Government to improve access to local early childhood services and ensure they are inclusive of families on low incomes.

They also want to see the Government invest in rebuilding midwifery and health visiting workforces as well as rolling out integrated services like family hubs across the country. This requires additional investment to address the shortfalls of 2,500 full-time midwives and 5,000 full-time health visitors in England by 2030.

Vicky Nevin, Policy Manager at the NSPCC and co-author of the report, said:

“Midwives, health visitors and other professionals provide support that can make a real difference for parents who want to do the best for their young children but are struggling with money.

“Worryingly, our research shows that service doors are often closed, hard to reach, or out of touch with the needs of families impacted by poverty. This poses serious risks to the health, wellbeing and safety of little ones.

“Early childhood services should be top of the agenda when the Child Poverty Taskforce next meets this December. It is vital for the Government to rebuild and reform services that provide quality support to all babies, young children and their families.”

Responding to the report, Alison Morton iHV CEO said:

“The scourge of poverty and lack of joined-up high-quality support for families is damaging the life chances of too many. We thank the NSPCC and UNICEF UK for laying bare these challenges in their “Opening Doors” report this week. We also thank them for adding their weight of support in calling for a significant increase in the number of health visitors in England, to ensure that all families can have access to high-quality support when they need it. A collective voice is a powerful voice – and partners across the sector are ready, willing and able to work with the government to turn this into reality.”

Read Opening Doors: access to early childhood services for families impacted by poverty in the UK report

New report launched: An audit of practice education infrastructure for SCPHN in Greater London

The Institute of Health Visiting (iHV) and London NHS England Workforce Training and Education Directorate (NHSE WTED) launch a new report: An audit of practice education infrastructure for Specialist Community Public Health Nurses (SCPHN) in Greater London.

iHV was delighted to be awarded funding by NHSE WTED to complete an audit of practice education infrastructure for SCPHN in Greater London.

Numbers of SCPHN health visitors and school nurses have decreased by more than 40% in England and London is one of the hardest hit areas[1]. To address workforce expansion needs, the London SCPHN workforce was offered a range of training and educational programmes to support practitioner professional development and growth of a learning culture. Reversing workforce shortfalls requires action to expand and improve training opportunities. Specifically, SCPHN workforce education infrastructure was identified as an important factor which could impact on the sustainable expansion of SCPHN Student community placements across all London 0-19 provider organisations.

The iHV completed an audit of practice education infrastructure at two separate time points – when the training was introduced and 6 months later. The audits explored whether targeted investments in practitioner development had been matched with an upturn in the organisational learning culture and infrastructure to support learning. The audit questions were framed using the four levels of learning (reaction, learning, behaviour, results) from the Kirkpatrick Evaluation Model[2].

Key findings from the audit included:

Improvements were seen in the learning environment across the duration of the project.
There is evidence to suggest that the education infrastructure and learning culture within London has been strengthened with:
- Practitioners reporting greater use of learning in practice over time
- Examples of perceived ability to provide better care
- Improved professional development
- Improved job satisfaction
- An improved learning environment.
Factors considered important to support learning in practice included:
- Supervision and a supportive learning environment
- Embedding learning for impact
- Improved time and capacity for practitioners to participate in Continuous Professional Development (CPD).

Our findings have been presented in a report and summarised into two engaging infographics. Whilst this audit has provided information on the unique context of the SCPHN workforce in London, it is also hoped that the findings will provide transferable learning to SCPHN providers across the UK who may be experiencing similar workforce issues.

You can view the report and infographics here
(to cite this report, please use this link https://bit.ly/3Y4rw3E).

The Audit for Education project forms part of a wider commissioned piece of work with London NHSE WTED which includes the student SCPHN recruitment pathway development review and a charter for enabling a good learning environment.

Nicky Brown, Senior Nurse for CYP OHID London, said:

“It has been such a pleasure working within the London system to develop the role of specialist public health nurses and their teams. This project has enabled London’s 0-19 Public Health Nursing workforce to explore areas of development in their own practice and the way they learn and teach others. It is hoped that this project is the beginning of an integrated approach to learning and development for all qualified health visitors and school nurses and their teams across London.”.

Caroline Ward, Clinical Workforce Transformation Manager – Maternity and Neonates, Children and Young People, Public Health and Community Nursing and Return to Practice, said:

“I am so pleased that I was able to achieve funding through legacy HEE to support such a vital piece of work. A well-trained and sustainable specialist community public health nursing workforce supply is vital to improving the health and wellbeing of our children, young people and families in London. Working with our London systems and service providers is key to the project’s philosophy to enable those who recognise the huge workforce challenges to be supported to work together with us to find solutions and ultimately make a difference within London and beyond.”

Jenny Gilmour, Lead for NHSE WTE London Improving SCPHN (HV/SN) Education Infrastructure and SCPHN Student Expansion Project, said:

“It has been a pleasure to work with the iHV to lead on the Audit of Education as evaluation of this important opportunity to invest in improving the SCPHN Education Infrastructure across London. The report evaluates the impact of the initiative within the current SCPHN workforce. And these results are positive, as evidence suggests that the current workforce, despite the very real pressures of achieving service delivery, has risen to the challenge. As a result, the SCPHN workforce has been prepared, and is ready and able to improve the quality of SCPHN student placements, as well as support expansion across London 0-19 Provider Organisations over the next few years as required under the NHS Long Term Workforce plans.”

Georgina Mayes – iHV Health Visiting Professional Lead (Quality and Policy) said:

“I was delighted to lead on this very important project which has the experiences of London SCPHN practitioners at its heart. SCPHN workforce shortages are of national concern and this project showcases how increasing and improving training opportunities can support professional development and growth of a learning culture which in turn can address SCPHN workforce expansion needs. I’m excited to see how our recommendations will be translated into practice.”

We would like to say a heartfelt thank you to London NHS England Workforce Training and Education Directorate (NHSE WTED) for their generous funding of this project, and to OHID London and the Chief Public Health Nursing Directorate (DHSC) for their professional advice. We would also like to thank the survey respondents, co-design workshop participants for generously sharing their experiences and insights with us, and to members of the iHV Health Visiting Advisory Forum (HVAF) who tested the audit survey.

Download report: An audit of practice education infrastructure for Specialist Community Public Health Nurses (SCPHN) in Greater London

(to cite this report, please use this link https://bit.ly/3Y4rw3E).

References

[1]NHS Digital Source: NHS Digital. NHS Hospital & Community Health Service (HCHS) monthly workforce statistics October 2023. 2024. [accessed 23 April 2024]. Available from: https://bit.ly/3JUw3h6

[2] Kirkpatrick Partners (2024) Demonstrate Training Effectiveness with The Kirkpatrick Model. 2024. [accessed 23 April 2024]. Available from: https://bit.ly/44wd5H6

Lord Darzi’s review on the state of the health service in England

Lord Darzi’s independent review on the state of health services in England has concluded that the service is in “serious trouble”, with long waiting lists, a deterioration in the nation’s underlying health, and problems for people accessing services. Focusing on children, the review highlights soaring demand for child health services, with too many babies, children and young people waiting years for treatment. Lord Darzi is clear that the solution is not to build more hospitals, but instead to follow the evidence and invest in better community care, stating that:

“When things go wrong the knee-jerk response from ministers has been to throw more money at hospitals where the pressure is most apparent as waiting areas fill up and ambulances queue outside.

“The result is that NHS has implemented the inverse of its stated strategy, with the system producing precisely the result that its current design drives. The problems are systemic. In the current paradigm, patients have a poorer experience, and everybody loses – patients, staff and taxpayers alike.”

The Institute of Health Visiting provided evidence and data for the review. And we are delighted to see Lord Darzi’s recognition of the challenges that services are facing, alongside acknowledgement of the crucial role that health visitors play in child health and development in the early years, stating:

“The Health and Social Care Act moved the commissioning of public health services to local authorities. As we have seen, the public health grant has fallen by more than 25 per cent in real terms. This has had a particular impact on Health Visiting, where numbers of health visitors have fallen … Given the extensive evidence base on the importance of the first 1,000 days of life; it is clear the NHS is missing an opportunity to intervene early.”

Commenting on the review, Alison Morton, iHV CEO said:

“The findings from the Darzi Review are shameful for a developed nation such as ours. Yet, they are not surprising given years of neglect of our healthcare services – they echo the issues that we have repeatedly raised over too many years. Childhood is short and the impacts of delays in care and treatment during these crucial developmental years are magnified and are unacceptable. Our babies, children, young people and families deserve so much better.

“Importantly, the report does not shy away from the stark realities – we can’t fix a problem until we are honest about it! We welcome the spotlight that this review has shone on the current state of services and are keen to work with the new government to push ahead with their plans to create the healthiest generation of children ever. This needs to include actions to fix the foundations of health by rebuilding health visiting services.”

This week, iHV also submitted evidence to the Spending review, setting out our call for investment in health visiting and case to rebuild services. It is precisely because the government faces a tight fiscal settlement that action needs to be taken to address the soaring costs of preventable problems which have their roots in early childhood. Failure to invest in prevention has been a costly mistake, with spending on late intervention spiralling out of control across health, education and social care.

The evidence is clear that investing in our nation’s children represents the smartest of all investments, with spending in the earliest years yielding the greatest return on investment across the life-course.

Read the Darzi Review here

Read iHV submission to the 2024 Spending Review here

iHV welcomes new RCPCH report to transform child health services in England

New policy report published today by the Royal College of Paediatrics and Child Health (RCPCH), “From left behind to leading the way”, offers a blueprint for transforming child health services in England.

“Children’s health services could lead the way as part of a transformed health service”.

This important RCPCH report emphasises the urgent need to prioritise children’s health services in the UK. The report shines a light on the chronic underinvestment in children’s health services, challenges faced by children, and the importance of equitable access to healthcare. The report advocates joint working between primary care and paediatric teams, and a Child Rights-Based Approach in planning and delivering health services. It stresses the significance of recognising children as a distinct group with specific health needs and calls for increased investment, workforce strategies, and national oversight to ensure sustainable child health services.

The key role of health visiting services is highlighted and, in particular, the services’ role in crucial areas related to child health and wellbeing. The impact of cuts to health visiting services on children’s health outcomes are reported, including recognition that “many families have been left without the early support that they need”. The report advocates the importance of health visitors in addressing the rising trend of 0-4-year-olds attending Emergency Departments and references our iHV report.

The RCPCH report considers health visiting as a crucial component of child health services, promoting the health and wellbeing of babies, children, young people and their families. It highlights the need to reinvest in health visitors and school nurses to provide earlier help for children and families and reduce reliance on specialist or urgent health services when not needed.

Vicky Gilroy, iHV Director of Innovation and Research, said:

“The iHV welcomes this comprehensive report from the RCPCH and the recognition of the importance of the role of health visitors as a central component of child health services. The need to reinvest in the crucial role of health visitors should not be underestimated. The impact of the reduction in health visiting services provision over the last decade has a direct impact on child health outcomes. There is an urgent need to prioritise child health and address the needs of babies and young children. Ultimately, we need more health visitors.”

To read the full report click here

Read the full RCPCH press release

Latest NMC registration data is a wakeup call to rebuild health visiting

Today, the Nursing and Midwifery Council (NMC) published the latest data on the number of registered nurses and midwives, alongside intelligence on the reasons why registrants are leaving the profession. Whilst the headline message is that there are more nurses, midwives and nursing associates in the UK than ever before, the aggregate data mask a significant problem for Specialist Community Public Health Nurses, with numbers in decline.

Headline messages:

Annual NMC data show that the number of registered nurses, midwives and nursing associates has grown by 37,723 (4.8%) to a record 826,418.
Nearly 60,000 new nursing and midwifery professionals joined the NMC register this year alone. This was split almost equally between UK and internationally educated joiners.
There are more nurses, midwives and nursing associates on the NMC register than ever: 826,418. That’s an increase of 37,723 (4.8 %) compared to the same period last year, and 128,184 (18.4 %) over the last five years.
The number of leavers as a proportion of the register has fallen, but data show that one fifth of people leaving did so within ten years of joining the profession.
After retirement, poor mental and physical health, and burnout are frequently cited reasons for leaving the professions.

SCPHN data:

In contrast to growth in other parts of nursing and midwifery, in England the number of Specialist Community Public Health Nurses (SCPHN) has fallen by 1.5%.
In the devolved UK nations, there has been an increase in the number of SCPHN on the register, with a 2.8% increase in Northern Ireland, a 2.1% increase in Scotland and a 2.4% increase in Wales.
NOTE: the number of SCPHN (health visitors) on the NMC register does not correlate with the number of health visitors working in practice. Many practitioners with a SCPHN qualification in England are now working outside the profession.
Published workforce data on the number of SCPHN health visitors employed in England (NHS workforce data and Independent workforce data) highlight an ongoing and worrying trend, with 40% fewer health visitors employed in England since 2015 – and numbers continue to fall every year.

Commenting on the report, Alison Morton, iHV CEO says:

“The latest NMC data present a worrying picture of the ongoing depletion of the health visitor (SCPHN) workforce in England – this is easily missed in the NMC’s headline message of aggregate data showing workforce growth across nursing and midwifery as a whole.

If we are serious about prevention, early intervention and improving the health of babies, children and families – this cannot be ignored or masked any longer! England is an outlier compared to the other UK nations, with health visitor data moving in the wrong direction year-on-year. Despite health visitors’ best efforts, families with babies and young children face the brunt of these cuts, with too few health visitors to meet their needs at a time when child health is deteriorating, and health inequalities are increasing.

Today’s NMC evidence must be used by those with the power to drive change for the better. Action is urgently needed to increase the number of health visitors joining the profession and reduce the number leaving. In particular, action is needed to address the worrying trend of high workforce losses within the first few years after qualification, with better support for newly qualified health visitors to improve retention. Most importantly, we need to value these highly skilled professionals and support their wellbeing, to reduce work-related stress and poor health that is driving too many people out of the profession.”

Read the NMC annual data report in full here

iHV responds to NHS Provider’s ‘forgotten generation’ report

90% of trusts say children’s health and wellbeing not high enough national priority
Just 16% of trusts keeping up with demand for CYP services
Three-year waits for some autism and ADHD assessments
Cross-government plan and public health boost needed

A forgotten generation’s life chances are being harmed due to delays accessing care according to a new report “Forgotten Generation: Shaping better services for children and young people” from NHS Providers, published earlier this week.

The NHS is struggling to meet rapidly rising demand and increasingly complex and acute care needs among children and young people.

There is deep concern among leaders of NHS trusts about the long-term harm caused by delays in services for children and young people (CYP), including a widening health inequalities gap.

Now NHS Providers is calling for a cross-government plan to improve the wellbeing of children and young people including more investment in early intervention and preventing ill health.

Waits for a range of essential services including health visiting, speech and language therapy, hearing tests, neurodevelopmental services (such as autism and ADHD) and paediatric surgery add to the stress and anxiety of patients, families, carers and NHS staff.

One trust reported that waiting times for children’s autism assessments had increased from around 14 months pre-pandemic to 38 months now.

Findings include:

Nearly all (97%) trusts responding said demand for CYP services has increased since the Covid-19 pandemic.
86% said waiting times for initial assessments had increased compared to pre-pandemic
90% said that the health and wellbeing of children is not considered enough in national policy
82% said they cannot meet current demand and 75% would be unable to meet anticipated demand in next 12-18 months
86% were concerned about the impact on staff morale of challenges providing care

Alison Morton, iHV CEO, commented:

“This stark report from NHS Providers highlights, yet again, the importance of prioritising child health – we cannot afford to have a forgotten generation. The new government’s commitment to create the healthiest generation of children ever is welcomed and actions need to start immediately to turn this into reality. Currently, millions of babies, children and young people are being left without the support they need, with devastating impacts, both personally and across society. Families, healthcare providers and think tanks are all calling for better healthcare throughout childhood, as well as actions to address the wider determinants of health – this cannot be ignored any longer. Health visitors are an important part of the solution and are ready and willing to rise to the challenge and build a healthier future.”

Read Forgotten Generation: Shaping better services for children and young people report

Also read iHV 2024 General Election Manifesto

Royal report sets out strong business case for prioritising early childhood

Today, The Royal Foundation Business Taskforce for Early Childhood has published a report setting out the business case for prioritising early childhood. The report, Prioritising early childhood for a happier, healthier society, has been produced by Deloitte on behalf of the Taskforce and sets out the huge scale of opportunity for business to drive, and benefit from, prioritising early childhood in the workplace, community and wider society.

It details how investing in early childhood could generate at least £45.5 billion in value added for the national economy each year. This includes £12.2bn from equipping people with improved social and emotional skills in early childhood, £16.1bn from reducing the need to spend public funds on remedial steps for adverse childhood experiences, and £17.2bn from supporting parents and caregivers of under-fives who work.

A number of new initiatives have been announced, including funding for early years apprenticeships and leadership programmes, increased support for baby banks, and creating welcoming spaces for families with young children.

The Taskforce was established in March 2023 by The Princess of Wales to galvanise business action on early childhood. Since then, Taskforce members Aviva, The Co-operative Group, Deloitte, Iceland Foods, IKEA UK and Ireland, The LEGO Group, NatWest Group and Unilever UK, have worked together to identify the scale of the opportunity and the role that business can play.

A joint statement from eight founding CEOs calls on “businesses of all sizes, across the UK, to join us and help build a healthy, happy society for everyone.”

Christian Guy, Executive Director of The Royal Foundation Centre for Early Childhood said:

“Today marks another milestone moment in our work to make early childhood a priority across society. Some of the most significant businesses in Britain have joined forces to deliver a major rallying call to their fellow business leaders to prioritise young children and those who care for them – for the good of our society and economy.

“Whether it is helping families access the support they need, prioritising the social and emotional well-being of children and the adults in their lives, or building a culture that prioritises early childhood, business has a significant part to play.”

Welcoming the report, Alison Morton, iHV CEO, said:

“This important programme of work, led by the Royal Foundation Centre for Early Childhood, is shining a much-needed spotlight on the social and economic case for investing in the earliest years of life. It is wonderful to see so many businesses joining this call and adding their weight of support. The commitments that have been announced today will quickly bring benefits to so many. They also lead the way for a lasting shift in our society that values early childhood and a legacy that can be proudly handed on to the next generation.

“The extent of the work of the Royal Foundation is far-reaching and we thank them for their ongoing support for health visiting and our work to improve the support that families with babies and young children receive.”

The report identifies five areas in which businesses of all sizes can have the opportunity to make the greatest impact for children under five, the adults around them, the economy and wider society:

Building a culture that prioritises early childhood within businesses, local communities, and wider society.
Helping families facing the greatest challenges access the basic support and essentials they need.
Offering parents and carers greater support, resources, choice, and flexibility with their work.
Prioritising and nurturing social and emotional skills in young children and the adults in their lives.
Supporting initiatives which increase access to quality, affordable and reliable early childhood education and care.

The release of the report is accompanied by a new business-focused area on The Centre for Early Childhood’s website containing practical information and resources.

Read the report

Children’s Commissioner launches The Big Ambition survey report

Today, the Children’s Commissioner has launched the results from her ‘Big Ambition’ survey. The survey, which engaged over 350,000 children, young people and adults, covered 10 themes of family, education, social care, youth work, online safety, health, safety from crime, jobs and skills, unaccompanied children seeking asylum, and thoughts on ‘a better world’.

The report details that just one in five children in England believe their views are important to the adults who run the country, while only 10% of teenagers believe they have the power to influence the issues they care about.

Findings from the survey show that this generation of children is engaged with the world, full of practical solutions and optimistic for their futures – but they are frustrated and disempowered because their experiences are rarely reflected in policy making. Children are keen to resolve the kinds of issues and worries that were previously unique to adults. They want to be asked what they think and their responses listened to, with action taken to affect change.

The survey also captured the voices of babies by asking parents to respond on their behalf and by engaging with organisations that advocate on their behalf. The iHV was delighted to be able to engage with the team at The Children’s Commissioner’s Office and to participate in roundtable discussions, presenting the views of thousands of health visitors who engage with millions of babies every year.

The Children’s Commissioner, Dame Rachel de Souza said:

“I want this paper to serve as a call to action, for whoever forms the next government, to decide now that they will commit all their energy and effort to improving the lives of children.

“The policies proposed in this paper draw directly on what children themselves told us. As such, they are ambitious. They would make the rights children are entitled to a reality and provide a positive vision for what childhood could be like if only it were reimagined through the eyes of children.

“Children don’t feel the need to debate why it will be beneficial in the long term to ensure that every family has sufficient financial capacity to support their children. They simply state that no child should go hungry, because it is wrong. They do not talk in the language of targets, and they do not set the bar at what is simply easy to achieve. They speak in terms of fairness. Children believe that true inclusion means that no child is left out. As such, our policies are designed to improve the lives of all children.”

The Children’s Commissioner will shortly be publishing a cohesive and ambitious policy framework for the next government to improve children’s lives and to make the rights children are entitled to a reality. This will include a welcome recommendation for a joint children’s workforce strategy to ensure those working with children are caring, professional and equipped to do their jobs, and that there is a strong pipeline into senior leadership roles. And this includes a call to strengthen health visiting. The recommendation aims to ensure, “additional health visitors are recruited so that all babies and children receive their checks in person, regardless of where they live, and can access the ongoing support they need.”

iHV CEO, Alison Morton, joined the launch event in Parliament today. As supporters of #ChildrenAtTheTable, we back the @ChildrensComm call to action in #TheBigAmbition for the next government to commit to putting all their energy and effort towards improving the lives of children and young people. Read #ChildrenAtTheTable response to #TheBigAmbition: https://buff.ly/3IRParG

Go to The Big Ambition survey report

Institute of Health Visiting launches ADBB study findings

Today, the Institute of Health Visiting (iHV) is delighted to share the overwhelmingly positive findings from their mixed-methods feasibility study into the use of the Alarm Distress Baby Scale (ADBB) in routine health visiting practice in England.

The study, commissioned and funded by The Royal Foundation Centre for Early Childhood, was conducted in partnership with Professor Jane Barlow from the University of Oxford. It sought to explore how acceptable and feasible health visitors found using the baby observation aid, the ADBB, and its shorter modified version, the m-ADBB, during their routine 6-8-week visits to families.

During the ten-month study, health visitors trained in the ADBB and m-ADBB were recruited from South Warwickshire NHS Foundation Trust and Humber Teaching NHS Foundation Trust. Quantitative and qualitative data were collected over a four-month period, during which the trained health visitors used their enhanced skills and knowledge to observe babies’ behaviours and interactions and identify those in need of a more thorough assessment or additional support.

Health visitors described the ADBB approach as “hugely beneficial” and “of great importance” to their practice. Findings demonstrate that both training programmes (ADBB and m-ADBB) were rated highly by all study participants, giving a new theoretical perspective, additional knowledge and skills, and a new vocabulary for explaining their observations of a baby’s behaviour. The use of the shorter validated 5-item version of the scale, the m-ADBB, was found to require minimal additional time and was considered easy to embed into routine health visiting practice (for example, the observation could be undertaken when parents were undressing their baby, or the baby was being weighed). Using the m-ADBB in this way enabled health visitors to:

Have more meaningful conversations with parents and carers about the emotional wellbeing of their baby;
Promote positive parent-infant interactions, attachment, and bonding; and
Identify those babies and families in need of greater support during this critical period of development.

Dr Jane Barlow, Professor of Evidence Based Intervention and Policy Evaluation at The University of Oxford, who oversaw the evaluation of the trial said:

“Babies are born with amazing social abilities. They are ready to relate and engage with the world around them, communicating how they feel through their behaviours.

“Whereas previous approaches have focused on the parents’ perspective, this training has really helped health visitors to ‘read’ the baby during interactions and develop greater sensitivity in terms of the observation of potential attachment and bonding issues that would not have been identified without the training.

“The feedback from those involved has been overwhelmingly positive. It is truly exciting to think about the impact this could have on families right across the country as we enter the next phase of this research.”

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

“Babies can’t talk, but there is now good evidence that they can communicate their experiences of the world around them when we tune in to their behaviours. We are therefore delighted by the positive findings from this study which found that the modified ADBB tool was very workable within universal health visiting practice, providing an important new way for health visitors to observe babies interacting with the people around them. There are many reasons why a baby might be distressed or withdrawn. Spotting these problems as early as possible is important as it will enable health visitors to work with families to ensure that they get the right support and babies can thrive.”

During the study period, health visitors identified behavioural concerns in 23 (10%) of babies as a result of using the m-ADBB. Health visitors were then able to work with families to explore the many possible reasons for this and determine the most appropriate next steps. All identified families were offered additional support, ranging from follow-up visits, emotional wellbeing visits and video interaction guidance (VIG) as well as connections to Child and Family Centres and referrals to Specialist Perinatal Mental Health and other local support services where indicated.

Conclusions and next steps

The quality of interactions that a baby has with their parent or caregiver is associated with their long-term development outcomes. Health visitors have a key opportunity in their routine contacts with families to promote optimal parent-infant interactions and identify emerging concerns. However, assessing these interactions can be quite complex, requiring a robust theoretical understanding as well as sound clinical observational skills.

The ADBB training introduced health visitors to the concept of social withdrawal – a coping mechanism that babies may use if they are experiencing some sort of stress in the environment around them. The additional understanding gained from observing babies’ behaviour from this perspective sat very well alongside health visitors’ existing skills. It helped them to consider how babies let us know they are ‘here, and engaging with the world’ and identify where additional support may be needed.

Executive Director of The Centre for Early Childhood, Christian Guy, said:

“The quality of the relationships between babies and their parents or carers, during the first weeks and months of life, shapes their developing brains and lays the foundations for their future health and wellbeing. So, it is vital that we provide families with the best possible advice and support at this crucial time.

“The results of the initial phase of testing are so encouraging. We now want to move quickly to ensure we build on this work, bringing the benefits of this model to more health visitors across the country so that, ultimately, more babies and their families get the support they need to thrive.”

In light of the positive findings of this study, the report includes recommendations for a second phase of research and evaluation of the tool in the UK context. In addition to several suggested research strands, consideration should also be given to:

a UK-based training programme with amendments to the training to align with the UK context, incorporating the training improvement recommendations from this study
Evaluation of the impact of training in more health visiting sites across the UK
Support systems for health visitors if ADBB/m-ADBB are adopted within health visiting practice, to include continuing professional development, supervision, learning resources and practice opportunities

The iHV, in partnership with the University of Oxford, would like to express its sincere thanks to The Royal Foundation Centre for Early Childhood for funding this important study and for their support and oversight throughout the study period.

Training in the ADBB and m-ADBB was kindly provided by Alexandra Deprez and Jocelyne Guillon of Humagogie training centre. Further details can be found at adbb-scale.com.

To read the full report and recommendations click here

To cite this report , please use the link to the pdf here: https://bit.ly/4a7z2hT

The research team would like to acknowledge the governance and guidance of the Expert Advisory Group:

Alison Morton (Chair) – Institute of Health Visiting
Dr. Sarah McMullen – The Royal Foundation Centre for Early Childhood
Hannah Sereni – Start for Life Unit
Wook Hamilton – Parent-Infant Foundation
Professor Crispin Day – South London and Maudsley NHS Foundation Trust
Lynne Reed and Wendy Nicholson – Office for Health Improvement and Disparities
Sarah Muckle – City of Bradford Metropolitan District Council, Director of Public Health
Professor Carl May – London School of Hygiene & Tropical Medicine

And the dedicated health visitors, managers and research departments at the Humber Teaching NHS Foundation Trust and South Warwickshire University NHS Foundation Trust who participated in the study.

Watch Sky News article: ‘Overwhelmingly’ positive results for trial funded by Princess of Wales as part of early years work