iHV publishes evaluation report of the iHV PIMH Champions Programme

iHV publishes ‘Transforming Perinatal and Infant Mental Health: A mixed-methods evaluation of the iHV Champions Programme’

The iHV is delighted to share the very positive findings of a mixed-methods evaluation of their flagship Perinatal and Infant Mental Health Champions Training Programme. Results suggest that the Programme is a credible, effective, and scalable approach to workforce development and system transformation. Practitioners who are trained as Champions are shown to become local leaders, driving improved care through enhanced knowledge, motivation, and collaborative practice.

The iHV has been delivering training in mental health since 2013, initially to health visitors and, subsequently, to multi-agency audiences. There are currently over 4,500 Champions trained across the whole portfolio which now includes perinatal and infant mental health, fathers, and LGBTQI+ people programmes. Thanks to generous funding from The AIM Foundation, the iHV research team, led by Dr Sharin Baldwin, conducted a three-part evaluation that included:

Analysis of pre- and post-training data across different training formats
An online survey completed by 111 Champions from across the UK
Thirteen in-depth qualitative interviews supplemented by three case studies

Reflecting the views of a total of 2,151 participants, the evaluation shows that the Programme enhances practitioners’ understanding and capacity to support families, while fostering leadership, advocacy, and system-wide change throughout the UK.

The report findings were launched today, 9 September, at the iHV PIMH Champions Forum. These quarterly online events were established as one of the key elements of the Programme, along with bulletins, webinars, and conferences, that enable continuous professional development for Champions and create opportunities for multi-agency networking across the UK. The evaluation findings highlight the value that Champions place on being part of this wider iHV community of practice, fostering a sense of shared purpose and motivation.

Alison Morton, CEO iHV, said:

“We have known for many years that the iHV PIMH Champions Programme is a clinically and cost-effective model to ultimately make a difference for babies, children, and families. Now we have the evidence to prove it. When Champions are well-supported by their organisations to engage fully with professional networks, and cascade our highly-regarded, evidence-based programme locally, they make a huge difference. We see earlier identification and support for parental and infant mental health problems that lead to better outcomes and reduced health inequalities.”

To read the full report, click here

To cite this paper, please use this link: https://bit.ly/4ngbiOC

For further information on any of the iHV training programmes, click here or contact [email protected]

To find out more about the history of the iHV Champions Programme and its underlying Theory of Change see Research Papers Published – iHV.

iHV attends launch of RCPCH report ‘Vaccination in the UK: access, uptake and equity’

A report from the Royal College of Paediatrics and Child Health (RCPCH), being launched today in the House of Lords and attended by Alison Morton (iHV CEO), has highlighted the significant barriers and difficulties some parents face to get their child vaccinated from serious but preventable diseases and calls on governments to act now to prevent future outbreaks.

Professor Helen Bedford and Alison Morton at the House of Lords launch

The World Health Organization recommends a 95% vaccination rate to keep vulnerable groups, such as babies, the elderly, and those who are immunosuppressed, safe through herd immunity. Concerningly in the UK, not a single routine childhood vaccine has hit that target since 2021. Over the past few years, measles and whooping cough (pertussis) have seen a resurgence in the UK due to declining vaccination rates and waning immunity.

Concerned by this downward trend, RCPCH set up the Commission on Immunisation Access, Uptake and Equity and, over a 12-month period, examined national data and research, and gathered first-hand experiences from parents, healthcare workers, and children to understand what’s really preventing uptake.

The Commission concluded that the core challenges lie in logistical and systemic shortcomings and that the current system is fragmented, hard to navigate, and too often fails the very families who need it most. The Commission also found that research and public health resources are sometimes misdirected by focusing too heavily on vaccine hesitancy, when in fact there are many parents who want to vaccinate but simply can’t access services that work for them.

Alison Morton, CEO of the Institute for Health Visitors, said:

“Whilst most parents get their children vaccinated without hesitation, the widening inequalities and decline in vaccine uptake rates are a national cause for concern. This timely report presents a compelling case to ensure babies and children are protected against serious diseases that were once feared by families and can cause so much unnecessary harm.

“The good news is that there is lots of evidence on how to reverse the current trend – captured in the practical recommendations of this report. By working together across national government and local systems, we can tackle the systemic barriers that make it harder for some families to get the vaccines their children need. This includes investing in health visitors who remain parents’ first port of call for trusted advice and, with sufficient funding, are ideally placed to deliver vaccinations to vulnerable groups.”

The report highlights the critical role of the system in addressing access-related barriers, which can deter families, especially those with questions about vaccination, from seeking immunisation for their children. When asked about these obstacles parents reported:

Difficulty booking appointments, especially ones that fit around work commitments and childcare needs
Transport challenges, including inconvenient clinic locations and the high cost of public transit
A lack of continuity in care, with many parents seeing a different GP or clinician at each visit. The absence of health visitors was especially significant, as it limited understanding of individual family circumstances that could influence vaccination decisions
A lack of reminders from GP offices about upcoming vaccinations, parents and carers also reported having no easy way to determine what vaccines their children have and have not had, with no set digital records available.
A fear of being judged for raising concerns about vaccines or having beliefs in alternative medicine.

The report also underscored the growing disparity in vaccine uptake among some ethnic minority groups, socioeconomically disadvantaged families and migrant communities. These groups reported specific challenges such as limited access to information due to language difficulties, digital exclusion, challenges in navigating the NHS, and a lack of targeted outreach.

In order to reverse declining vaccination rates, the UK must prioritise investments in infrastructure, digital health records for children, staffing levels and staff training. By addressing systemic barriers to access, including those which may more frequently affect underserved communities, the delivery and access to vaccinations can be improved for all.

The Institute of Health Visiting is working with NHS England on its plan to improve vaccination uptake through its Pathfinder project. The aim of the project is to improve access and uptake of childhood vaccinations in underserved groups. The Pathfinder project will test different models of enhanced health visiting provision across a mix of sites across England. The project’s recent call for expressions of interest attracted a huge amount of interest, with numerous submissions setting out a range of enhanced health visiting model options. These included vaccinations delivered during a home visit by a health visitor, vaccinations delivered by another registered healthcare professional who accompanies the health visitor on a targeted home visit, and community outreach approaches led by health visiting teams to administer vaccines in alternative settings, such as health visitor child health clinics or Family Hubs.

Alison concluded:

“We are confident that, when adequately resourced, health visitors can play a significant part in improving vaccination uptake, by building relationships with families, providing a trusted source of advice to answer their questions and supporting families to register with GPs and book appointments. With the right training and vaccination infrastructure, they are also ideally placed to provide options for vaccinations at home or in community settings if families face specific challenges in accessing vaccinations. However, we cannot ignore the challenges that health visiting services currently face in England, with huge disparities in services across the UK, and a national health visitor workforce shortage.

“The message to the government is clear – health visitors want to be part of the solution and ensure that all children get the healthcare they deserve. But it is essential that the government also plays its part and fulfils its pledge to strengthen health visiting, rebuild the health visitor workforce and end the postcode lottery in healthcare that families are currently experiencing.“

Read the full findings and recommendations for change in the RCPCH report ‘Vaccination in the UK: access, uptake and equity.’

Also read Alison Morton's blog in Nursing in Practice: Health visitors to play integral role in improving childhood vaccinations uptake

iHV welcomes new UNICEF report calling for more health visitors

UNICEF UK has undertaken new analysis which demonstrates that where children grow up has a significant impact on their early outcomes, with inequalities in health and developmental outcomes entrenched in the first few years of life. Key findings include:

Every Local Authority in the top 20% for deprivation is in the bottom 20% for multiple measures of child health and development.
The most deprived quintile of LAs are more than twice as far away from meeting the Government’s target for 75% children to reach a good level of development than the most affluent areas.
Five-year-olds in the most deprived LAs are three times more likely to have teeth removed due to decay than those in the most affluent areas.
Obesity rates for five-year-olds are twice as high in the most deprived areas than in the most affluent areas.
Babies and young children in the most deprived areas have 55% more visits to A&E than those in the least deprived areas.

While the school-based measures the Government has announced are welcome, this analysis demonstrates that inequalities are already well established by the age of five. Ahead of the Comprehensive Spending Review, UNICEF UK is therefore calling on the Government to urgently address the links between deprivation, poverty and developmental outcomes within the earliest years by:

Removing the two-child limit and benefit cap
Restoring investment in essential early childhood health and support services

The Institute of Health Visiting is delighted to see that the second recommendation includes a call on the Government to increase investment in health visiting. This includes adding their weight of support to the iHV policy recommendation to rebuild the health visiting workforce by recruiting an additional 1,000 health visitors a year over the spending review period. Health visiting is highlighted throughout the report as a crucial service which has an important role to play for all babies and young children, but which can be particularly valuable for babies and families experiencing poverty, as provision can help mitigate against the impact of poverty on early outcomes. We are delighted that UNICEF references our iHV State of Health Visiting reports in this new report.

Read UNICEK UK report - Held back from the start: the impact of deprivation on early childhood

See UNICEF UK Deprivation Heat Maps

Invest in Childhood: new report calls for Government action

Invest in Childhood: new report calling for Government action to prevent mental health problems in babies, children and young people.

The Centre for Mental Health has launched a new report focused on the critical issue of mental health for babies, children and young people and the imperative of addressing mental ill-health. The Invest in Childhood report sets out how the Government can act now to prevent mental health problems among children and young people. It explores the available evidence about how government can use its powers to boost family mental health, investing in what works and how to most effectively direct resources.

Invest in Childhood says that the Government can turn around the rise in mental health problems among children through evidence-based, cost-effective prevention strategies. The report identifies six critical areas for immediate action, from the perinatal period and early years, to schools and colleges, and through to entering the job market.

Of particular note to health visitors is the recommendation for expansion of the workforce and recognition of the unique role health visitors play in promoting good emotional health and wellbeing of the whole family. The report says that health visitors play a vital role in promoting good mental health in children and families, and in spotting the signs of mental health difficulties early. However, it recognises that the profession has faced successive cuts to the workforce, meaning that more children fall through the gaps of early support and go on to need specialist care. Invest in childhood calls on the Government to take action now, saying that boosting the number of health visitors will benefit babies, children and families for decades to come.

‘Health visiting is a cornerstone of early childhood support, offering a unique opportunity to engage with families during the formative years of a child’s life’

(Invest in Childhood report, 2025)

The report recommends the following:

The UK Government should take steps to tackle the social determinants of children and young people’s mental health. Current legislation to improve workers’ and renters’ rights are welcome measures towards this aim. Action to tackle violence against women and girls, child poverty, and racial injustice will further address some of the biggest drivers of mental ill health among children and young people today. A whole government mental health strategy, backed up with a mental health policy test and a Mental Health Commissioner, would strengthen the machinery of government so that future policies are made with children’s mental health in mind.
The UK Government should create a nationwide programme to invest in community-led mental health promotion and mental illness prevention activity. This could be modelled on the Better Mental Health Fund, to enable local councils across the country to support community initiatives to improve children’s mental wellbeing. This should focus on the most disadvantaged and marginalised neighbourhoods and groups of people in each locality.
The UK Government should invest in evidence-based parenting programmes, adopting a proportionate universal approach with a low-cost offer for all and additional help for those who need it. Some local and combined authorities have begun to implement this locally.
The UK Government should improve mental health support for mothers during the perinatal period, building on the expansion of specialist community services to provide a more comprehensive support offer.
The UK Government should expand the health visitor and school nursing workforce. Public health nurses play a vital part in supporting children’s mental and physical health, and as such are a good long-term investment.
The UK Government should support early years education settings, schools, colleges and universities to adopt a whole education approach to mental health. Applying a mental health policy test to education policies would further embed the whole school approach by providing greater consistency and evidence-based policies, for example around the curriculum and the ways behaviour and attendance are managed in schools.
The UK Government should fulfil its manifesto pledge to establish an open access mental health hub in every community in England. These will provide early support for young people’s mental health, and also help with housing, employment and other essentials for young adults up to the age of 25 making the transition to working life. These issues should be central concerns of the Government’s forthcoming Youth Strategy

Hilda Beauchamp, PIMH Lead at iHV, said:

“This timely report draws our attention, again, to our most vulnerable citizens. The declining mental health of babies, children and young people in England requires an urgent, informed and co-ordinated response, especially in the current context of economic and global instability. We welcome the Centre for Mental Health’s recognition of the pivotal role that health visitors play in identifying early signs of mental health difficulties in babies and young children and providing essential support and early intervention to families. We would urge the Government to heed the evidence highlighting the clinical and cost-effectiveness of a well-resourced health visiting service and respond urgently to the recommendation to expand the workforce.”

The report concludes that the evidence is clear: to secure a brighter future for babies, children and young people, we must invest in childhood. By harnessing the possibilities that technology brings, building on the evidence of what makes a difference, and creating health-enhancing environments, we can empower young people and families, support educators, and tackle the broader challenges of disadvantage. These actions are essential steps towards preventing mental health problems and fostering a generation of young people who are healthy, resilient, and capable of achieving their full potential.

Click here to go to the report

Read Institute of Health Promotion and Education Rapid Response to report published in BMJ:

BMJ: Charity calls for more health visitors and school nurses to tackle rise in child mental ill health

Safeguarding reviews “silent” on needs of Black, Asian and Mixed Heritage children

A new report highlights failures to recognise the safeguarding needs of Black, Asian and Mixed Heritage children, revealing limited attention to race, culture and ethnicity in reviews of practice. This meant that the safeguarding needs of Black, Asian and Mixed Heritage children were often overlooked in child protection.

The Child Safeguarding Practice Review Panel (CSPRP) has published a report which focuses on 53 children from Black, Asian and Mixed Heritage backgrounds who died or were seriously harmed between January 2022 and March 2024. These children were subject to horrific abuse, including sexual abuse, fatal assault and neglect, with 27 children tragically dying as a result.

The report aimed to explore the unique safeguarding needs of children from these ethnic backgrounds and assess how agencies intervened to protect them in time. It uncovered a significant “silence” to address race and racism in child safeguarding, with many local areas neglecting to consider the impact of race, ethnicity, and culture.

The overarching aim of this report was to identify and analyse how these issues are seen and addressed to identify both good or emerging practice, and areas for learning and improvement in multi-agency safeguarding practice. The key findings from the report include:

Limited attention to race and ethnicity: Reflection on practice lacked necessary critical analysis, depth, and detail which meant that identifying learning and good practice was challenging.
Silence about racism: The safeguarding needs of Black, Asian and Mixed Heritage children and families were too often rendered invisible in both practice and the system for learning from reviews.
Missed Opportunities: There are too many missed opportunities in practice and in our system of learning about incidents when children have been seriously harmed or died. This can leave children vulnerable, at risk of harm, and without the support and protection that they need.

The report recognises that everyone will have their own experiences of making sense and addressing race, racism and racial bias which may affect confidence in identifying and confronting matters relating to these issues. The report highlights how we all have a professional responsibility to take ownership of developing our own confidence and capacity to address these important issues effectively. The need for good support and challenge from our teams and leaders were also recognised as being important, so that these issues can be explored together and where critical discussions are welcomed and normalised.

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

“This report highlights a deeply concerning silence around race and racism in child safeguarding. To ensure we protect all babies and children, it’s imperative that we acknowledge the specific risks and barriers faced by Black, Asian, and Mixed Heritage children. As health visiting professionals, it is crucial that we address racism and racial bias, and listen to families, to ensure every baby and child receives the support and protection that they need.”

The report shared some reflective questions which are helpful in prompting consideration of health visiting practice when engaging children and families from Black, Asian and Mixed Heritage backgrounds:

As a practitioner, how can you feel empowered to have conversations with children and families about race and identity, particularly when you are working with individuals from different cultural and ethnic backgrounds to your own?
As a practitioner, how confident are you that, when engaging with children, you consider all aspects of their identity and how these may intersect to influence risk and vulnerability? If you don’t feel confident, why might this be the case?
As a practitioner, do you feel confident that you understand the impact of race, culture and ethnicity on children and families, and on their experiences? If you don’t, what may explain a lack of confidence in this area? How do you explore this with children and families and create opportunities and spaces for them to discuss its impact?
How do you ensure you are self-reflective about your own biases when working with children and families from diverse cultural and ethnic backgrounds? How is this supported on an individual level, and within teams?
How can you be supported to effectively respond to the diverse communication needs for children and families, particularly when considering national issues concerning the availability and accessibility of interpreters and interpretation services?

The overarching recommendations from this report include:

Safeguarding partners to consider the learning from this report and the reflective questions (see the report for further detail on the reflective questions from a system and leadership perspective).
Safeguarding partnerships to carefully evaluate their current partnership work and identify what further development is needed in learning reviews, and multi-agency safeguarding practice, to address and respond to issues of race, racism and racial bias.

You can read the full report here

Exclusive iHV Insights webinar recording is now open access

Exclusive iHV Insights webinar recording is now open access: The Public health role in reducing A&E attendances

To help raise awareness of health visitors’ role in tackling the current crisis in urgent care services, we are delighted to share the recording of our recent iHV Insights webinar: “The Public health role in reducing A&E attendances” held on 16 January 2025.

Tackling increasing demands on urgent services is a national priority as too many patients are waiting too long in overcrowded A&E departments across the country. Our iHV report and film, published in December 2023, highlighted that babies and young children are the highest users of A&E, with the rate of children aged 0-4 years attending A&E in England increasing by 42% in the last 10 years. When reviewed, a large proportion of these attendances did not require hospital treatment and were for non-urgent conditions (for example, minor illnesses, feeding problems, and parental distress due to infant crying), suggesting that they could be managed and supported by other means, including health visitors in the community.

Following the Darzi review, the new government has proposed three “shifts” in health care to ensure that services are fit for the future – this includes shifting care from the hospital to the community and a much greater emphasis on prevention. Health visitors can play an important part of the solution to addressing increasing demands on urgent care services through their ‘upstream’ work in prevention and early intervention – supporting parents to manage minor illnesses by improving health literacy is a central function of health visiting.

This webinar brought together a leading panel of expert speakers who explored the health visitors’ public health role in reducing A&E attendances alongside the latest national data and context of 0–4-year-olds attending A&E:

Honorary Professor Damian Roland, Consultant in Paediatric Emergency Medicine, Leicester, Leicestershire & Rutland Urgent and Emergency Care System Clinical Director
Georgina Mayes, iHV Health Visiting Professional Lead (Quality and Policy)
Kate Walters, Divisional Director of Nursing & AHPs, Children & Family Services and CAMHS

This webinar brings into sharp focus the unique needs of babies, young children and their families and the importance of ensuring that they can access the right healthcare support when they need it – right person, right place, right time.

Help us raise awareness and drive meaningful change to improve healthcare support for families. Please share the webinar and short iHV film “Can you see my baby? Health visitors prevent emergencies” on the vital role of health visitors in reducing A&E attendances for babies and children aged 0-4 years with your commissioners, local MPs and Health Boards.

Honorary Professor Damian Roland said:

“Emergency Department attendances reflect inequalities in society and the systems response to them. Understanding, and addressing, underlying reasons for Emergency Department attendances will ultimately improve the long-term life chances of Children and Young People.”

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

“Health visiting is an important part of the solution to reducing A&E attendances. This webinar highlights the vital role of health visitors in providing expert, professional support to families when their baby or child is unwell. More health visitors are urgently needed now to ensure all families can get the support that they need, which will in turn take pressure off overstretched A&E departments.”

Kate Walters, Divisional Director of Nursing & AHPs, Children & Family Services and CAMHS, said:

“Parental confidence and the importance of understanding your baby is crucial to the decisions that parents and carers make about accessing health care – where to go, what to do and what is the most appropriate. Health visitors play a key role in building this understanding and helping parents to navigate the health system. Health visitors can provide signposting, advice, digital support, and are accessible to all.”

Watch the full iHV Insights recording:

Watch short iHV Film, “Can you see my baby? Health visitors prevent emergencies ”

Join the conversation and share your thoughts on how we can work together to support babies, young children, their families and communities more effectively #HealthVisiting #ReduceA&EAttendances #Prevention.

This webinar is part of a series of iHV Insights events produced for iHV members to support their continuous professional development and help them keep abreast of the latest issues in child and family public health. Not a member? Consider joining us. Our corporate membership provides exclusive access to expert-led events, resources, and networking opportunities designed to support health visitors’ professional development and practice. Individual UK membership is also available in four different categories: Associate, Student, Friend, and Retired

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