The Royal Foundation expands support for health visitors to “give babies a voice”

Further investment from The Royal Foundation Centre for Early Childhood to support health visitors to “give babies a voice” following the publication of the iHV ADBB Phase Two Study.

Today, the iHV, in collaboration with the University of Oxford, published the findings from its latest evaluation of the use of the Alarm Distress Baby Scale (ADBB) in health visiting practice across the UK. We are also delighted to announce that we will be able to continue to support embedding of the tool within health visiting thanks to further investment from The Royal Foundation Centre for Early Childhood.

The tool, known internationally as the Alarm Distress Baby Scale (ADBB), is used by health visitors within routine checks to promote infant wellbeing. It focuses on a baby’s social behaviours such as eye contact, facial expression, vocalisation, and activity levels to help practitioners and families better understand the ways babies express their feelings and to help parents and carers with bonding and attachment. It can also be used to recognise early signs of psychological distress, enabling specialist support to be accessed as soon as it is needed.

Our evaluation found that:

ADBB training addresses a clear gap in health visiting practice by strengthening understanding of infant social withdrawal and increasing practitioner confidence in observing and interpreting babies’ behaviour.
Health visitors reported feeling better equipped to articulate the baby’s perspective, an area they felt is often less emphasised in other training, which tends to focus more on parental behaviours. This enhanced ability to “give the baby a voice” supported richer, more balanced conversations with parents.
There were measurable changes in practice at the 6–8‑week postnatal review. The proportion of babies identified with concerns increased from 7% to 12%. Yet, importantly, referrals to specialist services reduced, suggesting that ADBB supports earlier identification of emerging needs and enables more proportionate responses within universal services.
Parents described the 6–8‑week review as reassuring, supportive and confidence‑building. They particularly valued warm, non‑judgemental communication, a clear explanation of their baby’s behaviour and cues, feeling listened to, and emotional support and validation. When introduced clearly, ADBB‑informed observation was experienced as collaborative and empowering.

Eileen Perrins, Perinatal & Infant Mental Health Lead, Institute of Health Visiting, explains more (with thanks to Debbie Barrett & Darren Alderson-Hall – Hampshire & Isle of Wight Healthcare NHS Foundation Trust for co-ordinating, the staff at Bridgemary library for hosting and for all the parents and their wonderful babies for taking part in the filming):

Next steps in this project

The Royal Foundation Centre for Early Childhood has today announced next steps in this project to build upon the positive independent evaluation of the phase two study, with recommendations for ADBB to be commissioned across the country.

Her Royal Highness The Princess of Wales first saw the tool in use when she met health visitors in Denmark in February 2022, and The Centre has been working with the Institute of Health Visiting (iHV) ever since, to bring the benefits of the approach to families in England, Wales, Scotland and Northern Ireland.

Phase one of the study ran in two NHS Trusts from May 2023 – February 2024, exploring the feasibility of implementing a modified version of the tool (m-ADBB) within health visitors’ routine 6-8-week checks with families. It had overwhelmingly positive results.

Phase two of the study, which ran from October 2024 – March 2026, then explored the impact of training health visitors in the ADBB and its modified version (m‑ADBB), across eight sites throughout the UK. This phase set out to assess how training influences practitioners’ knowledge, confidence, and practice; examine changes in identification, referrals and support at the 6–8-week postnatal review; and explore parents’ experiences of the approach.

To support local authorities to take up the use of the tool, The Centre for Early Childhood will fund the iHV to produce a guide to commissioning ADBB, as well as to develop new resources tailored to a UK audience. In line with a key recommendation from the evaluation, The Centre will also fund iHV to create a new ADBB Community of Practice for the next three years, to support practitioners in the continued use and embedding of the tool. This will play a central role in supporting ongoing learning, supervision, and peer support, helping to ensure practitioners are supported to safely and effectively embed the approach in routine care.

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

“The findings reinforce the role of health visitors as highly skilled practitioners, able to build trusted, therapeutic relationships with families and to guide sensitive, open discussions. Getting the right support to families at an early stage can have a hugely positive impact on a baby’s whole life. We want every commissioning body in the UK to consider using this tool so that every family with a newborn can benefit.”

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

“By equipping practitioners and families to understand what babies are communicating from the very start, we can give infants a stronger voice in early conversations, identify where extra support may be needed earlier, and help families build the responsive, nurturing relationships that we know are so important in shaping lifelong outcomes.

“The more health visitors are trained in this use of this tool, the better equipped they will be to help, which is why we are so determined to do everything we can to support its roll out across the UK.”

While the study found the training to be acceptable and impactful, it also makes clear that learning to observe and interpret babies’ behaviour is complex and requires ongoing practice, supervision and support. Successful implementation depends on organisational readiness and system‑level conditions including manageable caseloads, continuity of care, protected time, and clear governance and referral pathways.

ADBB Phase Two Study Report:

Please read the full report here

Boost infants’ life chances with more health visitors, cross-party Committee tells Govt

Today, the Health and Social Care Committee published its long-awaited report on its Inquiry into the First 1000 Days. The new report highlights that the UK has some of the worst health outcomes for young children in Europe and asserts that improving access to health visitors and Family Hubs, whilst boosting vaccine uptake, would help improve the lives of infants in England.

The cross-party Committee’s report focuses on the first 1,000 days of life, from conception to age two. This period is universally recognised as a critical window for shaping brain development and future mental and physical health.

The last decade has seen a collapse in the number of health visitors – meaning they can’t help everyone who needs it because of excessive caseloads. One of the Committee’s primary recommendations is that the Government must commit to recruit at least 1,000 more health visitors in the first instance, to halt the decline in health visitor numbers and rebuild this vital workforce. They also recommend action to end the postcode lottery, with all families receiving at least 6 mandated health visitor contacts during the early years – and a longer term ambition to deliver a service comparable to the rest of the UK.

Another important recommendation is that Family Hubs should be rolled out to more communities where need is greatest. Family Hubs should also offer improved perinatal mental health services to caregivers.

Health visitors are also central to the recommendation to improve access to vaccinations and uptake, with a new strategy which should aim for 95% coverage throughout England. It should explore ways to train health visitors to deliver vaccinations; increasing the size of the workforce should simultaneously improve vaccination rates.

Speaking on behalf of the Committee, Paulette Hamilton MP said:

“Children growing up in our country today stand too great a chance of becoming overweight, developing asthma or tooth decay, or catching life-threatening yet preventable diseases due to missed vaccines. The Royal College of Paediatrics and Child Health says the UK has some of the worst health outcomes for young children in Europe. This should be a source of shame.

“Over the last two decades we have seen a hollowing out of health services for infants – the Family Hubs programme still barely touches the sides of what was once provided by Sure Start centres before they were forced to close. And our provision of health visitor appointments is woefully inadequate in some parts of the country.

“This Committee now calls on the Government to reestablish health visiting as a cornerstone of the state’s support for families in communities across England, offering help with perinatal mental health, advice on a range of issues on health and development and helping to get more children vaccinated against illnesses which should be all but non-existent in 21^st century Britain.”

Responding to the report, Alison Morton, iHV CEO, who provided written and oral evidence to the Committee’s Inquiry, said:

“We welcome the Health and Social Care Committee’s thorough review of the first 1000 days and were pleased to contribute evidence to the Inquiry. We particularly appreciate the Committee’s recognition of the vital role that health visitors play in supporting families in these formative years, and its clear call for urgent action to rebuild a workforce that has been severely depleted over the past decade. This is something that the iHV has called for over many years as health visitors see the human face of years of cuts which have left too many families without the support they need. We look forward to the Government’s response and offer our ongoing support to turn its ambition to ‘give every child the best start in life’ into reality.”

Highlights from the Inquiry presented in the report:

Call to revive the health visitor workforce

UNICEF and the NSPCC highlighted the essential work of health visitors in addressing inequalities and giving parents space to discuss sensitive concerns about their baby’s development.

But the number of health visitors has plummeted over the last decade. By December 2024 there were only 6,300 in England – a 43% reduction since 2015. Our CEO, Alison Morton, gave written and oral evidence to the committee and this features heavily in the report, with a clear case to reduce health visitor caseloads which have become unmanageable in many areas (you can watch Alison’s oral evidence session here, with iHV written evidence submission in our news story).

Recommendations:

The Committee recommends that the Government must commit to recruiting 1,000 health visitors, and to use individual caseloads as a measure of how many will need to be recruited every year.
The Government must set out steps to improve poor performance of local authorities where families are not receiving sufficient health visits.
Ministers should commit to increasing the number of mandatory health visitor contacts for children in England from five to six, alongside plans to scale up the health visitor workforce. England is an outlier in only mandating five health visits – Scotland mandates 11 visits, Northern Ireland mandates nine visits, and Wales six.

Family Hubs in every community

Family Hubs are local centres that act as one-stop shops for children and caregivers, offering access to midwives, health visitors, GPs, youth workers, family support workers, and early years practitioners. Research by the Centre for Social Justice found that every £1 spent on Family Hubs saves £2.60 in provision of services later in a child’s life.

Recommendations:

The Government should set out plans to expand the Family Hub network to every community, with ringfenced, long-term funding (beyond the current £500m tranche of funding up to 2028/29 set out in the current policy).
Clear guidance on how Family Hubs will work alongside Neighbourhood Health Centres to avoid potential overlap.

Vaccination Strategy branded a failure

In 2024, the UK recorded the highest number of measles cases since 2012, with 2,911 confirmed cases in 2024 and one child dying. 11 infants tragically died from whooping cough in the same year.

The UK’s routine immunisation schedule provides protection against 15 vaccine-preventable infections during childhood, including in the first 1,000 days of life. While the UK Health Security Agency’s latest annual data shows modest increases in vaccine coverage for children up to age five, the latest quarterly data shows that coverage decreased across all vaccinations, part of “an ongoing declining trend”.

Recommendations:

The Government should accelerate a pilot scheme of training health visitors to deliver vaccines to families in their homes or at medical centres and Family Hubs.
The Government should reinstate its target, based on World Health Organization advice, to achieve 95% vaccine coverage across England.
The 2023 Vaccination Strategy should be branded a failure and a new plan should be developed with a specific focus on improving uptake. The Committee recommends that every Integrated Care Board should have a named officer with responsibility for vaccinations.

Perinatal mental health support

The Committee reported that they were struck by the amount of evidence it received regarding perinatal mental health concerns and links with negative impacts on mother-infant attachment and the child’s emotional and psychological development, leading to long-term issues in mental health, emotional regulation, and resilience.

Recommendation:

The Government should set out actions to improve access to perinatal mental health care within Family Hubs, supported by specific targets to improve access for women from ethnic minority backgrounds.

Read full report here

Kingdon audiology investigation: important lessons for all child health services

The independent “Kingdon review of children’s hearing services: final report” was published last week – commissioned following the identification of a series of failures in the screening and care of deaf children. The review findings reveal systemic failures across the NHS and Department of Health, that left hundreds of babies and children with undiagnosed hearing problems, causing lifelong developmental harm.

In common with health visiting, childhood audiology has been described as a ‘Cinderella service’ (in other words, services that are often overlooked, undervalued and underfunded); with quality concerns repeatedly ignored, the service struggled with serious underfunding, endemic workforce issues, and inadequately trained staff became the norm.

The review, led by Dr Camilla Kingdon (consultant neonatologist and former President of the Royal College of Paediatrics and Child Health), was commissioned by the Secretary of State for Health and Social Care, in April 2025, to review the response of NHS England to service failures in children’s hearing services and to make recommendations for improvement.

Dr Camilla Kingdon said:

“The programme has not been set up for success. It has not had the power to mandate regional structures or integrated care boards (ICBs) to initiate incident response processes and has operated with fewer staffing and budget resources than that requested by its senior responsible owner (SRO). It has therefore not been able to deliver improvements to children’s hearing services at the same time as co-ordinating a national review and recall programme, despite admirable efforts made by individual members of staff.”

Alison Morton, iHV CEO, was an expert contributor to the review. In response to the report, Alison said:

“The findings of the Kingdon Review are deeply concerning – and provide a serious ‘wake-up call’ to everyone delivering child health and development screening and support services. I thank Dr Kingdon for her detailed and thoughtful review which shines a light on the normalisation of sub-standard care – this cannot be the level of care that we tolerate for our children.

“Too many babies, children and families are being let down by services that are not equipped to deliver good quality care or meet the scale of need. My thoughts are with those affected by these failures from a service that should have protected them.

“At the iHV, we believe in a better future and that change is possible! We will continue our work with partners to push for high-quality child health services for all – and we won’t stop!”

The Kingdon Review makes twelve recommendations – these ensure that the NHS understands the scale of the problems which have been caused, place children’s hearing services on a secure footing for the future, and apply the lessons from these failings to other similar services. We welcome these recommendations and join with others in calling for their full and speedy implementation.

Read the 'Kingdon review of children’s hearing services: final report'

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