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.”
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.”
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.
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
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.
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
Findings from Kindred2 “annual school readiness survey” were published today and report that more children in England and Wales are starting school without the basic skills needed to learn, leaving them disadvantaged from the start. The findings from this important survey provide a stark warning to policymakers, educationalists and practitioners working to give every child the best start in life, including health visitors.
To understand “school readiness” for children starting Reception last autumn, the early years charitable foundation Kindred2 commissioned Savanta to conduct focus groups and survey over 1,000 teachers and 1,000 parents of Reception children:
More than three-quarters of teachers say they are spending more time supporting children who are not school ready.
1 in 4 children are starting school not toilet trained.
30% of children can’t communicate their needs to tell teachers if they are hungry or scared or need to go to the toilet. More than a third couldn’t dress themselves.
A quarter don’t have basic language skills.
According to the survey, nearly half (46%) of pupils are unable to sit still, 38% struggle to play or share with others, more than a third (37%) cannot dress themselves, 29% cannot eat or drink independently, and more than a quarter (28%) are using books incorrectly, swiping or tapping as though they were using a tablet.
Half of teachers say the problem is worse than last year and every child loses out as an estimated 2.5 hours of teacher time is lost each day; and 9 in 10 teachers say this impacts the rest of the class.
Schools say pressures are also affecting staff retention: almost half (47%) of the teachers in the survey said they are considering leaving their current role, and nearly a quarter (23%) plan on doing so in the next year.
49% of parents think that some children start school not ready because parents are unaware of the expectations of school readiness. The report also highlighted that “early help” was patchy with wide variation in the level of support that families received from a health visitor. More than one in five (22%) of parents had received no visits from a health visitor before their child started school, and the majority (63%) had two visits or fewer. 69% of school staff think parents need more guidance about child development milestones.
The full report includes comments from focus groups held with teachers and parents:
“Over the last 20 years… we’ve noticed a change in the children – the children at entry points from when they come into Reception are not as school ready as they were when I first started.” – Teacher
Felicity Gillespie, Director at Kindred², said:
“The shocking findings in this year’s report should be a watershed moment for schools and parents because we know that children who are behind before they begin Reception are more likely to struggle throughout life. The 40% attainment gap we see at GCSE is already evident at age 5… we need to question why the critically important first key stage of our education system doesn’t start until age five – when we know that we all start learning from birth.”
Alison Morton, iHV CEO, said:
“Health visitors have a vital role to play in ensuring that all children are supported to be ready for school. When adequately resourced, they are in a privileged position as the only service that proactively and systematically reaches all families with babies and young children – we need to maximise these important opportunities to prevent and identify problems early to ensure that all children get the support that they need to be ready to learn when they start school. However, following years of cuts to the health visiting service, too many families are not receiving this vital support. Cuts have consequences and sadly children are the innocent victims. We urgently need more health visitors.”
In case you missed it – last week, the Child Safeguarding Practice Review (CSPR) Panel released its fourth annual report which is described as a barometer of the health of the national safeguarding system, highlighting both strengths and areas for improvement in multi-agency practice. The report provides important insights into patterns in English safeguarding practice, examining learning from incidents where children have died or suffered serious harm due to abuse or neglect.
In the Foreword to the report, Annie Hudson, the Chair of the Child Safeguarding Practice Review Panel, reminds us that, “The children at the heart of this report endured shocking, almost indescribable, violence and maltreatment. We must never become inured or habituated to this. What happened to these children cannot be undone, but what we must do is assess how well agencies responded to their needs.”
The findings presented in the 2022/23 annual report are based on:
serious incident notifications (SINs) during the 15-month period of January 2022 to March 2023 with a focus on the 12-month period of April 2022 to March 2023
rapid reviews with incidents that occurred during the 12-month period from April 2022 to March 2023
a sample of Local child safeguarding practice reviews (LCSPRs) produced during the 15-month period of January 2022 to March 2023
letters to safeguarding partnerships from the Panel used to assess the quality of rapid reviews during the 12-month period of April 2022 to March 2023.
The review also draws on evidence in the 2 national reviews and 2 thematic reviews the CSPR published in 2022 and 2023.
The Panel received 393 serious incident notifications during this period, with 37% (146) related to child deaths and 58% (227) involving incidents of serious harm to children.
Review highlights vulnerability of babies
Babies under the age of 12 months old comprised the single largest age group within the sample of rapid reviews (36%, n=142).
Over a fifth (26%, n=25) of serious incidents involving children under one year old occurred in the 10% most deprived areas compared to 15% (n=7) of children aged 1 to 5 years old.
Parental and family stressors were the most significant factor in escalating risk when it comes to safeguarding children under 12 months old. Previous reports like the Myth of Invisible Men and Bruising in Non-Mobile Infantsemphasised challenges in responding to this vulnerable group. The review builds on the key learning from the inquiry into the murders of Star Hobson and Arthur Labinjo-Hughes in highlighting the importance of professionals having the time to understand the context in which babies and young children are living:
“Knowing what life is like for children, highlighting the centrality of children’s voices and experience, and those of their parents, carers, and wider family members, but also the knowledge, skill and confidence required to build a full picture of children’s lives to enable the best safeguarding, support and protection.”
Understanding the roles and risks of all adults around very young children is crucial, given their dependence on caregivers and the potential for rapid escalation. The analysis also highlighted ongoing problems in effectively assessing and managing risks involving babies, with connections to domestic abuse, where pregnancy is a recognised risk factor in such relationships, posing challenges for professionals.
Parents’ and carers’ needs
Among the 393 cases reported to the Panel, 13% (n=51) involved parents under 25 years old, and 3% (n=13) had a history of being in the care system, although identification was sometimes challenging. This indicates a potential need for additional support from services like GPs and health visitors for these parents.
Conditions in practice
One of the main messages from the review is the importance of providing practitioners with the best opportunity to identify, assist and protect children. Specifically for health visiting, the following factors were found to hinder optimal practice and safeguarding decision making:
Major challenges in workforce recruitment and retention, most obviously in children’s social care and health visiting, which impact on the quality of practice. The review raises concerns about the year-on-year decline in the number of health visitors.
Increases in population numbers and levels of vulnerability – this includes evidence from the iHV Annual State of Health Visiting survey. Alongside the decline in workforce numbers, these place significant pressures on health visiting services in meeting the scale of need.
Limited GP input and incomplete health records in multi-agency meetings posed a common problem in recognising vulnerabilities affecting families. Inadequate information sharing between agencies, like neonatal units, midwives, health visitors, and GPs, especially in families with young children, significantly impacts the protection of children at risk of harm.
There was also evidence that questions about domestic abuse were not being asked during checks with mothers if fathers were present (this learning point applies regardless of sex and gender of both parents or main carers). While including fathers in checks and appointments is essential to avoid them becoming invisible to services, this finding emphasises the need to ensure that mothers can speak to health visitors alone in case the presence of the other parent inhibits disclosure.
The report emphasises the importance of working upstream to prevent situations reaching crisis point.
The report concludes with a series of reflective questions for safeguarding leaders to support them in promoting the very high standards of safeguarding practice and makings sure that learning reviews drive longer term change to help children and families. These questions are organised around 6 key strategic themes:
Culture: creating an inclusive culture where professional challenge is promoted.
Clear partnership intent: ensuring clear and balanced partnership working.
Strategy to delivery: ensuring strategy is carried through to frontline practice.
Assessing effectiveness: evaluating impact of the safeguarding system.
Getting upstream: ensuring learning feeds into prevention, early intervention and the commissioning of services.
Workforce: working together effectively across agencies and promoting development.
The Institute of Health Visiting (iHV) publishes its findings from the largest UK survey of frontline health visitors working with families with babies and young children across the UK – “State of Health Visiting, UK Survey Report: Millions supported as others miss out”.
It’s deeply shocking that 93% of health visitors reported an increase in the number of families affected by poverty in the last 12 months. Poverty was the cause of greatest concern to health visitors. They visit the homes that families are struggling to heat and witness the impossible choices that parents are forced to make about feeding their children or paying the bus fare to attend vital health appointments. These struggles are often hidden behind front doors and invisible to other services until the situation reaches crisis point. Alongside an increase in poverty affecting families over the last 12 months:
89% of health visitors reported an increase in the use of food banks
78% an increase in perinatal mental illness
69% an increase in domestic abuse
63% an increase in homelessness and asylum seekers
50% an increase in families skipping meals as a result of the cost-of-living crisis.
Only 3% of health visitors surveyed reported that families had not been impacted by the cost-of-living crisis. Some reported that poverty was so widespread that it had become the norm.
In our survey, health visitors also raised concerns about the wider impacts of poverty and increased parental struggle on children’s health, development and safety. The Government’s own data show that more children in England are falling behind with their development and health inequalities are widening. Worryingly, the situation is getting worse and showing no signs of recovery.
The good news is that health visitors saw millions of families last year, reaching significantly more babies and young children than any other health service or early years agency. However, despite health visitors’ best efforts, they are not able to meet the scale of rising need. Too many babies and young children are not receiving packages of support to improve their health and development when they need it, due to ongoing cuts to the health visitor workforce:
There is a national shortage of around 5,000 health visitors in England and families face a postcode lottery of support.
79% of health visitors said that the health visiting service lacked capacity to offer a package of support to all children with identified needs.
Only 45% of health visitors were “confident” or “very confident” that their service was able to meet the needs of vulnerable babies and children when a need is identified.
80% of health visitors said that other services were also stretched and lacked capacity to pick up onward referrals for children with additional needs. Thresholds for children’s social care support had increased and other services had long waiting lists.
Alison Morton, CEO at the Institute of Health Visiting, says,
“Consistently, health visitors have told us that parenting has become much harder for many families over the last 12 months. Health visitors are in a privileged position, they see firsthand the struggles that families with babies and young children are facing, often hidden behind front doors and invisible to other services. Sadly, despite policy promises, more and more children are not getting the “best start in life”. And the situation is getting worse with more children falling behind with their development and widening health inequalities. As babies can’t speak for themselves, health visitors provide a vital “voice” for our youngest citizens and an important warning signal for policymakers who are prepared to listen. It doesn’t have to be this way, change is possible.”
We publish at the start of a new year, with political and economic uncertainty, but also with hope as all political parties consider their plans to improve the health of our nation ahead of a general election expected this year. Our survey findings highlight the incredible potential and desire within the health visiting profession to support a brighter future for our nation’s children. But we cannot ignore the fact that the health visiting workforce is under significant pressure with unacceptable levels of work-related stress, as health visitors manage enormous caseloads, and escalating levels of need and vulnerability. We urgently need more health visitors.
Alison concludes:
“Our survey findings present a clear imperative to act. If we get the early years right, we can avoid so much harm later in life. The cuts to health visiting in England over the last 8 years have been a false economy. When sufficiently resourced, health visitors can take pressure off busy A&E departments and GPs, providing support for families in the heart of the community. The costs to rebuild the health visiting service in England are small compared to the spiralling costs of NHS treatment, child maltreatment and cumulative costs across the life course. Investing in our children’s health is not only the right thing to do, it also makes sound economic sense.”
Today, the House of Lords Primary and Community Care Committee published its report ‘Patients at the centre: integrating primary and community care’, in response to the consultation it held earlier this year.
The consultation explored the many challenges facing primary and community care and the sustainability of the NHS. These include high service demand, an ageing population, workforce shortages and insufficient preventative care. The Committee explored how integrating services could address these challenges and sought evidence from clinicians, community care services, local authorities, researchers and voluntary organisations from across the country.
The Institute of Health Visiting was asked to contribute to the consultation and we did this in a number of ways:
Alison Morton, iHV CEO, submitted written evidence in April 2023.
Professor Sally Kendall MBE, who is one of the iHV’s four founding health visitors and an Honorary Fellow, presented oral evidence as a witness.
Sarah Cartner, a member of the iHV’s Health Visitor Advisor Forum, and a health visitor from Newcastle Upon Tyne Hospitals NHS Foundation Trust, also represented the iHV at a roundtable event hosted by the Committee at the Palace of Westminster – read her Voices blog.
We were delighted to see that health visiting has been recognised as a key sector of the health service, within the report. The report also highlights the challenges of workforce shortages and fragmented models of care, alongside the hugely valuable service that health visiting provides to GPs and families. Evidence from Professor Campbell, Professor of General Practice and Primary Care at the University of Exeter is cited. He states, “Health visiting … has been hugely valued by GPs and their teams, but it is now no longer really part of general practice. Sadly, we have lost so many health visitors that we do not know who these people are or where they are. They provide a hugely valuable service, safeguarding and supporting families and people with long-term conditions.”
Alison Morton, iHV CEO, commented:
“We are delighted to see that health visiting has been recognised as a key sector of the health service by the Committee. The report also highlights the very real challenges of workforce shortages and fragmented models of care that are having a significant impact across the whole health and care system.
“In his evidence, Professor Campbell, Professor of General Practice and Primary Care, speaks for many GPs, highlighting how much they value health visitors and the work that they do to safeguard and support all families. He also raises valid concerns about the impacts of the depletion of the health visiting service in recent years which is hampering collaborative working. Close working relationships between health visitors and GPs are vitally important to support their collective work with all babies, young children and families, and particularly those living with complex conditions, risk and vulnerability. We share the Professor’s concerns and support the recommendations in this report. To deliver better joined-up care, we urgently need more health visitors.”
The Integration of Primary and Community Care Committee Report’s has 4 key recommendations:
Structures and organisation of NHS services need to be streamlined. Integrated Care Systems (ICSs) are a good starting point for collaborative working but their relationship with other healthcare bodies, public bodies, and local government must be based on mutual professional respect. The Department of Health and Social Care (DHSC) should evaluate ICS structures before implementing any major health service reforms.
There needs to be a more simplified and flexible system for awarding contracts and allocating funds within the NHS to encourage multi-disciplinary, integrated working. DHSC and NHS England (NHSE) should reform the contract process and ensure new contracts are flexible in the commissioning of primary care. The Government should explore different ownership models for GP practices to facilitate more joined-up and better care.
Efficient data-sharing is crucial to successful healthcare integration. Fragmented systems often require patients to repeatedly provide the same medical information, causing frustration. A properly maintained Single Patient Record (SPR) and the ability for intersectoral data-sharing between healthcare professionals are essential to tackle this issue. The DHSC must issue guidance to standardise data practices and clarify data sharing within privacy laws, to ensure timely patient access to medical data.
Equipping staff to work across multiple clinical disciplines through improved training will make integration of services easier. Currently, staff spend more time meeting everyday demand, rather than implementing new integration strategies. Clinicians should be introduced to the work of other services through job rotations. Social care needs should also be included in the NHS’s Long Term Workforce Plan to ensure that enough well-trained social carers are available.
Sally Kendall MBE, Professor of Community Nursing and Public Health at University of Kent, said:
“Despite some strong evidence to the Committee in relation to integration across all community services, it is disappointing that children’s health does not receive a lot of specific attention in the report. Childhood is lived in the home (wherever that may be), school, nursery and neighbourhood. There is a huge opportunity for ICBs to come together with local authorities and the NHS and voluntary sector to integrate health for all children and close the inequality gap. This opportunity may be lost for future generations of children if ICBs do not recognise the importance of the community services such as health visiting and school nursing and their navigational role with primary care and other community services to ensure that children’s health and safeguarding needs are met.”
Babies under one have the highest rate of Accident and Emergency (A&E) attendance: Health visitors can help overstretched A&E departments
A new report by the Institute of Health Visiting (iHV) reveals that the under ones are the largest group of people by far who attend A&E across the country. A large proportion of these attendances are for non-urgent conditions, suggesting that they could be managed and supported by other means, including health visitors in the community.
Addressing soaring rates of A&E attendance is a national government priority. A focus on prevention and meeting people’s care needs outside hospital is an important part of the NHS Urgent Care Recovery Plan – this needs to include children aged 0-4.
The new report reveals:
Babies under the age of one have the highest rate of A&E attendance compared to any other age group and the rate of 0–4-year-olds attending A&E has increased by 42% in the last 10 years.
The rate of potentially avoidable A&E attendances is much higher in babies and young children.
In North West London, 59% of babies who attended A&E did not need treatment and were sent home after reassurance, costing an estimated £1.8 million per year in this one area of London alone.
It is perfectly normal for parents to worry when their baby or young child is unwell. It can feel quite frightening, particularly for first-time parents who do not have good support networks. While A&E is the right place for very sick babies and young children, improving access to high-quality care in the community could help to reduce A&E attendance in babies and young children.
In the past, health visitors would have provided support to all parents to help them manage common childhood conditions such as feeding difficulties, minor illnesses and infant crying. However, due to a national shortage of around 5,000 health visitors – and cuts to the Public Health Grant that funds the service of £1 billion in real terms since 2015 – there are not enough health visitors to support families. And many health visiting ‘drop-in’ baby and child health clinics have been closed or scaled back in recent years.
These cuts are a false economy as they put pressure on other services including A&E departments.
We urgently need more health visitors to ensure that all families get the support that they need in the heart of their communities. Health visitors provide an important part of the solution to reducing the pressure on A&E departments, GPs, and wider health and social care services. When adequately resourced, health visitors are often the first point of contact for families when they are concerned about their child’s health. As Specialist Community Public Health Nurses, they provide a trusted source of information and can support families to manage minor illnesses through their ‘upstream’ work in prevention and early intervention in communities.
With so much compelling evidence, the Institute of Health Visiting has joined forces with leading paediatricians and is calling for urgent investment into health visiting so all families can get the support they need in the community and take pressure off overstretched A&E departments.
The iHV has also released a new film “Can you see my baby? Health visitors prevent emergencies” which showcases the vital role of health visitors in reducing A&E attendances for babies and young children. The film hears from parents about the crucial support that their health visitor provided to them, boosting their confidence in managing their child’s health.
Alison Morton, iHV CEO, commented:
“I am delighted to see this excellent report and film on A&E attendances in babies and young children launched today. As more and more parents and carers turn to A&E for reassurance and ‘peace of mind’ to manage common childhood illnesses, hospitals are struggling to cope. Our report is not about blaming parents. It is perfectly normal to worry when your baby or young child is unwell, particularly if you are a first-time parent and learning to manage these conditions for the first time. Building more hospitals is not the only solution.
“Cuts to health visiting services over the last 8 years have been a false economy with fewer health visitors available to support families through prevention and early intervention in the community. The knock-on consequences have been felt across the health and care system, including A&E departments. To tackle the problem, we need to provide better support for families in the heart of communities and this includes rebuilding the health visiting service in England.”
Georgina Mayes, iHV Policy and Quality Lead and the film’s Executive Producer, said:
“The iHV film and report paints a worrying picture of increasing A&E attendance for the under ones across the country, at a time when health visiting numbers are the lowest in history. Health visiting is an important part of the solution to reducing A&E attendances. This report and film highlight the vital role of health visitors in providing expert, professional support to families when their 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 Emergency Departments.”
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