Teachers report that growing numbers of children are not “ready for school”

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.”

Go to Kindred² School Readiness Survey Report and Infographic

Learning from the Child Safeguarding Practice Review Panel’s fourth annual report

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 Infants emphasised 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.

Read the CSPR Panel report in full here

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

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

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

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

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

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

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

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

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

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

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

Alison concludes:

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

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

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

House of Lords publishes Select Committee response to Integration of Primary and Community Care consultation

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.”

Links for further reading:

Read iHV submission to Integration of Primary and Community Care Committee (April 2023)

Read Sarah Cartner's Voices blog:

Babies under one have the highest rate of A&E attendance: HVs can help

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.”

View iHV report:

Read iHV report: Understanding the rise in 0–4-year-old Emergency Department (ED) attendances and changing health visiting practice

To cite this report , please use the link to the pdf here: https://bit.ly/471XYVB

Read Appendix 1 | A narrative summary of literature exploring the health visitor’s role in supporting parents with babies and young children with minor illnesses

Read Appendix 2| Case Study A: Healthier Together – an integrated, region-wide approach to improve outcomes for children and their families; and Case Study B: Health visiting in Hampshire: supporting a whole system shared-learning approach to address increasing demand on children’s Emergency Department (ED) attendances

Read Appendix 3 | Case Study: Boosting Health Literacy & Care: Digital Parental Support via ChatHealth messaging

Read Appendix 4 | An analysis of a randomly selected group of 100 infants under 12-months-old who attended Northwick Park Emergency Department (ED), North West London

View iHV short film, ‘Can you see my baby? Health visitors prevent emergencies’:

Watch film on Vimeo

iHV welcomes report: The maternal mental health experiences of young mums

The Children and Young People’s Mental Health Coalition and the Maternal Mental Health Alliance have, today, launched a new briefing exploring the mental health experiences of young mums.

Findings from a rapid review of the literature and focus groups with young mums from across the UK show that young mums aged 16-25 are at higher risk of experiencing mental health problems during pregnancy and after birth and face significant barriers in accessing support. Where they do access support, experiences of services can be poor.

Based on feedback received from young mothers, this briefing identifies 4 priority areas for action:

Listen and respond to the needs of young mothers in national and local systems
Resource and invest in universal and preventative services
Ensure access to specialist mental health services
Research and listen to the voices of young mums

An infographic depicting a ‘Dream City of Support’ informed by focus group discussions with young mums identifies health visitors as part of a range of services they would like to see in place. The briefing highlights the skilled, preventative work that health visitors offer and aligns with existing evidence that health visitors, when adequately resourced and trained, can provide clinically and cost-effective perinatal mental health care. However, the drastic reduction in the health visitor workforce over recent years means urgent action is needed to ensure that all families, and particularly those facing multiple disadvantage, are able to quickly access the right support.

Hilda Beauchamp, Perinatal and Infant Mental Health Lead at iHV, said:

“We welcome this timely report highlighting areas for action to improve services for young mums. We know that young mums are so much more likely to experience shame, stigma and judgment and that this can significantly impact their mental health. The rise in teenage maternal suicide rates highlighted in the recent MBRRACE report was sobering.

“At the iHV, we are fully supportive of the coalition’s recommendation to conduct an in-depth review of the circumstances surrounding these deaths. Currently health visitor records are not routinely examined as part of the Confidential Enquiry review process. Health visitors are the only health professionals that proactively and systematically reach all families with babies and young children throughout the perinatal period, including young mums. We would recommend consideration of the contribution that health visitors can make to the MBRRACE process to fully understand where change can be made in the provision of services across the whole pathway of care.”

Becoming a parent is challenging at any age, but many young mums experience additional difficulties such as experiences of care, isolation and loneliness, housing difficulties, poverty and employment discrimination, that contribute to poor mental health. Learning from best practice examples of holistic support for young mums across the UK is included in this briefing, adding weight to the recommendations for further work and research, including action required in the devolved nations.

The iHV fully supports the report’s concluding statement that:

For too long, young mums’ needs and views have been ignored. It is time their experiences were listened to, and their needs centred in the planning of perinatal mental health support.

Download full report: The maternal
mental health experiences of young mums

Download summary briefing: The maternal
mental health experiences of young mums

iHV joins former ministers and UK health experts calling for a new ‘Covenant’ for Better Health

A new report, A Covenant for Health, published yesterday, exposes the damaging effect that getting ill early in life with avoidable illnesses causes people, the economy and the healthcare system.

The report was led by a cross-party Commission of former ministers and health experts including Geoffrey, Lord Filkin CBE with Professor Kate Ardern; James, Lord Bethell; David Buck, The King’s Fund; Dr Paul Corrigan CBE, former Health Adviser, No 10; Professor Sian Griffiths CBE; and Professor David Halpern CBE, Behavioural Insights Team, with project support from The King’s Fund.

The iHV contributed evidence, insights and propositions to the Commission, alongside numerous other leading health organisations and charities including the Association of Directors of Public Health, the Royal College of Paediatrics and Child Health, and the Local Government Association.

The report outlines why change is needed. The “Old-fashioned” model of giving priority to treating illnesses and neglecting prevention has led to a “sickness explosion”. They state that “the time has come to fix the politics to reboot the health of the nation and develop an Emergency Programme for Better Health by all of society.”

It is urgent to act – the UK has among the worst population health in Europe, large health inequalities, and very many people become ill much earlier than they should. Without resolute action it will get worse. The good news is that change is possible. The report’s authors state that, “Too often in the past political leaders have focused on immediate pressures and been timid.”

The Commission concluded that with the right action across all parts of society, in 5 to 10 years, we should be able to:

help 3 million people quit smoking, halving our smoking rate
help 4 million people avoid becoming obese
help at least 4 million be more active
help more children be physically and mentally healthy, fewer at risk of obesity
reduce the 30,000 deaths a year from poor air quality
help 5 million people to reduce their risk of CVD, still 24% of all deaths
help the people and places where health is worst.

Commenting specifically on children, the report states, “Most parents want their children to be healthy. Yet many children have health risks and conditions and so are more likely to develop early long-term illnesses and later, risk falling out of work. There is no government strategy to improve children’s health, OHID have the lead but not the levers. We suggest a focus on four topics: obesity, mental health, physical activity and early years.”

The report also states that “The costs are small compared to the growth of the NHS’s budget and they would be born across society as well as by government. The benefits would be great. A new government should move fast, define early what it wants to achieve, prepare for it, legislate, if needed, and make difficult changes early.”

Commenting on the report, former Labour Government minister and Chairman of the Covenant for Health Commission, Lord (Geoffrey) Filkin, said:

“Our “health” system prioritises treating people when they are ill but grossly neglects action to keep them healthy. This outdated model means millions of lives are degraded by avoidable illnesses and results in unbearable costs for individuals, society, and the economy. We need a radical change of mentality to prioritise prevention with an Emergency Programme for Health. We know how to do so, we can make great improvements rapidly, and this essential reform will cost little.”

Lord (James) Bethell, former Conservative Government Health minister, said:

“The Office for Budgetary Responsibility made clear we are on the road to financial ruin unless we make our society healthier. The time has come to fix our politics so we can reboot the health of the nation. Our leaders should recognise the public do support measures to tackle smoking, obesity, heart disease and other chronic illnesses and address junk food, and dirty air, to support healthy communities and to engage people in their own health.”

At the iHV, we support the recommendations in the report for a Covenant for Health – a resilient cross-party commitment to build a healthier nation, and to develop partnerships for health with business, local authorities, and key charity groups.

Read the ‘Covenant for Health’ here

Government urged to act as ultra-processed foods dominate diets of UK babies and toddlers

In the news and media this week there have been many articles about the impact of ultra-processed foods on health, including a shocking Panorama documentary on this topic. A new report published today by First Steps Nutrition Trust outlines why this significant threat to our nation’s health needs to be taken seriously for babies and young children too.

The report ‘Ultra-processed foods (UPF) in the diets of infants and young children in the UK: What they are, how they harm health, and what needs to be done to reduce intakes’ exposes how ultra-processed foods (UPF) are widely consumed, from the first weeks and months of life, raising serious concerns about the ways that they are impacting on babies’ and young children’s health and contribute to the growing obesity crisis.

The key findings from the report are stark, with evidence that all commercial formula milks and a high proportion of ‘finger foods’, snacks and baby cereals are ultra-processed. The extent of this ‘ultra-processing’ is underestimated by most people due to poor product labelling that makes it harder for parents to spot the ingredients and processing methods that are linked to health and environmental harms.

Worrying data from the report show that by 2 to 5 years of age, UPFs account for nearly two thirds (61%) of the total mean energy intake of UK children – this is higher than Australia and the USA. It is clear from the growing evidence that the impact of UPFs on our health cannot be underestimated, some of these negative health outcomes include: the promotion of overeating; disruption of developing taste preferences early in life; interference with the healthy development of the gut microbiota; and wider harmful effects due to UPFs containing certain additives and contaminants with known harmful effects.

Despite this evidence, the UK currently lacks a clear position on UPFs and companies are allowed to use aggressive and misleading marketing to promote these foods and drive high consumption levels.

Vicky Sibson, Director First Steps Nutrition Trust, called on the government to act and said:

“It is now commonplace that many babies and young children in the UK are being fed large amounts of ultra-processed foods from the start of their lives. There is robust evidence that this will be harmful to their health in the short and long term, including promoting excess weight gain.

“The Government needs to do more to enable parents and carers to feed their children diets which support healthy growth and development – based on real foods – not dominated by commercial products marketed as ‘good’ choices.

“A first step would be to explicitly address the extent to which food is processed in public health recommendations. At the same time, action to curb inappropriate and misleading marketing by the baby food industry is long overdue. The Government also needs to invest meaningfully in the health visiting service, and other facilities and benefits, to ensure that all families can get the independent, expert advice, guidance and financial support they may need to feed their children healthy diets.”

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

“Our nation is sleepwalking into a health crisis that is largely preventable, with current and future generations condemned to an increase in unhealthy life expectancy and lives cut short due to unhealthy diets and ultra-processed foods. This important report by First Steps Nutrition clearly sets out the reasons why we need to take this seriously for our babies and young children who are currently the innocent victims of the ruthless marketing of these unhealthy products that are produced specifically for them.

“Healthy foods are needed to build healthy bodies and minds. If we are to break this trajectory of declining health for our nation, we need to change the beginning of the story and ensure that all babies and young children can eat healthy and affordable food. We fully support the recommendations outlined in this report and join the call on the Government to act – our children cannot wait any longer.”

First Steps Nutrition Trust makes these seven recommendations to the UK Government:

Acknowledge the NOVA classification and update public health recommendations on infant and young child feeding to explicitly address food processing
Regulate and enforce the composition, labelling and marketing of commercial baby and toddler foods and drinks
Ensure parents/carers have easy access to independent information and practical guidance and support on complementary feeding, and feeding from one to five years of age. This requires proper investment in the health visiting service and services like Family Hubs
Ensure parents/carers on low incomes can afford to feed their infants and young children nutritious diets based on real foods by reforming the Healthy Start benefit scheme
Enable women who want to breastfeed by increasing support, and by increasing legal protections for breastfeeding and against inappropriate marketing of commercial milk formula
Invest in research on UPF consumption in the early years, including on additives in commercial baby and toddler foods
Acknowledge and promote the environmental benefits of diets based on minimally processed foods

To read First Steps Nutrition Trust’s full report including the Forward by Dr Chris Van Tulleken, click here

Health visitors have an important role to play in supporting parents with infant feeding and healthy diets for the whole family. iHV members can access our comprehensive ‘Healthy Weight, Healthy Nutrition Toolkit’ to support their practice here – please ensure you log into the iHV website first, to gain access.

Specialist Health Visitors in Perinatal and Infant Mental Health

Specialist Health Visitors in Perinatal and Infant Mental Health: where they are and what they’re doing.

Maternal Mental Health Awareness Week 2023 (#MMHAW23) focuses on being ‘together in a changing world’. Today’s theme, Tuesday 2 May, offers an opportunity to ‘shine the spotlight on support’ – so what better time for the iHV to shine the spotlight on the unique role of Specialist Health Visitors in Perinatal and Infant Mental Health across all UK nations by giving a snapshot of where they are and what they are doing.

Seven years on from the seminal publication on the role of Specialist Health Visitors in Perinatal and Infant Mental health (Sp HV PIMH) by Health Education England¹ and one year since the follow-on report by Homonchuk and Barlow² made further specific recommendations for these practitioners, the Institute of Health Visiting (iHV) has compiled a snapshot of provision and practice across the UK – Specialist Health Visitors in Perinatal and Infant Mental Health: where they are and what they’re doing.

The good news is that there are now Sp HV PIMH in each UK nation, providing strategic leadership, undertaking pivotal training, education and supervisory functions, influencing service redesign and pathway development, and ensuring robust quality assurance through accurate data collection, analysis and audit. We regularly hear examples from Sp HV PIMH of how they continue to advocate for families and use their position and voice to influence local decision makers to ensure perinatal and infant mental health remains prominent in local policies and the political agenda.

A deeper dive at a regional level, however, reveals patchy provision and inconsistent commissioning arrangements for these specialists, with variations in:

job descriptions
clinical case-loading expectations
training and supervision for the practitioner
where the role sits – within universal health visiting or specialist perinatal and infant mental health services

In addition, the dire shortages in the health visiting workforce need to be urgently addressed by national government to enable Sp HV PIMH and the wider health visiting workforce to deliver clinically and cost-effective perinatal and infant mental health care.

Melita Graham, Head of Mental Health, says:

All families want and deserve high-quality and joined-up care for PIMH problems. This report highlights the unique leadership role that Specialist Health Visitors in Perinatal and Infant Mental Health have contribute to achieving this. Furthermore, it shines a light on how specialist provision within health visiting services offers the opportunity to drive clinically and cost-effective high-quality evidence-based PIMH care across the whole system.

There is still work to be done but much to be celebrated. The leadership and commitment of these pioneering specialist health visitors ensures that families at risk of, and those impacted by, mental health problems have the best chance of receiving timely, high-quality, cost-effective care within health visiting services and beyond, helping to give all babies and young children the very best start in life.

Recommendations

Recommendations from previous reports on Sp HV PIMH still stand², particularly that:

Sp HV PIMH should continue to be commissioned by every Local Authority in England, every Health Board in Wales and Scotland, and every Health and Social Care Trust in Northern Ireland. Such commissioning should include the provision of necessary resources to enable them to work both strategically and clinically
A national set of Perinatal and Infant Mental Health quality standards for Sp HV PIMH, health visiting and health visiting services are needed
The contribution and recognition of the Sp HV PIMH role would be strengthened by the development of credentials for Advanced Clinical Practice (ACP-health visiting)

In addition, this report recommends that:

All services should ensure there is a robust offer of reflective clinical supervision for Sp HV PIMH
Demand-driven workforce modelling with further exploration of workload weighting for Sp HV PIMH is needed to provide a benchmark for safer staffing and ensure equity of provision
Further research into the role of Sp HV PIMH within universal health visiting services compared to specialist services is needed to build a strong evidence base for the NHS and Local Authorities to make the best decisions in designing, commissioning and delivering services in the interests of local people
Further research is needed to support the translation of the evidence from the UK Confidential Enquiries into practice, focusing on public health aspects, inequalities and the Sp HV PIMH role
The health visiting service should be strengthened by national government through sufficient funding, a demand-driven, well-resourced national workforce strategy to ensure that all families receive high-quality, evidence-based support, regardless of where they live

Download report - Specialist Health Visitors in Perinatal and Infant Mental Health: where they are and what they’re doing

References

Health Education England. Specialist Health Visitors in Perinatal & Infant Mental Health. What they do and why they matter. 2016. Available from: https://www.hee.nhs.uk/sites/default/files/documents/Specialist%20Health%20Visitors%20in%20Perinatal%20and%20Mental%20Health%20FINAL%20low%20res.pdf [Accessed 19^th April 2023]
Homonchuk, O. and Barlow, J. Specialist Health Visitors in Perinatal and Infant Mental Health. 2022. Department of Social Policy and Intervention, University of Oxford. Available from: https://spi.web.ox.ac.uk/sites/default/files/spi/documents/media/specialist_health_visitors_in_perinatal_and_infant_mental_health_-_january_2022.pdf [Accessed 19th April 2023]

Promoting safer sleeping for babies in England: new report

At the start of Safer Sleep Week 2023, a new report is published today on promoting safer sleeping for babies. Health visitors have an important role to play in promoting safer sleep and ensuring that these important messages reach all families.

Change is needed to the way safer sleep information is communicated, if risks to babies from unsafe sleeping practices are to be reduced, according to a new report from Oxford, UCL, Bristol and Newcastle Universities. This was prompted by government, in the wake of sudden death in infancy data, in an attempt to identify what type of support was needed to reduce the incidence in all families.

The new report on promoting safer sleep for babies particularly focuses on families facing significant adversity, who may be receiving support from Children’s Social Care Services. While rates of sudden unexpected death in infancy (SUDI) declined steeply in the 1990s and continued to decline until 2014, families living in the most deprived neighbourhoods continue to experience a disproportionately higher rate; the National Child Mortality Database found that 42% of SUDIs occurred in deprived neighbourhoods, compared with 8% in the least deprived.

Researchers interviewed parents, talked to local professional services and studied data on decision-making and safer sleep interventions.

According to the report, a range of motivational factors play a key role in influencing decision-making about the infant sleep environment, including parents’ own needs for adequate sleep, and the need to bond with their babies. Research also suggests professionals responsible for conversations about infant sleep safety have concerns about providing personalised and tailored support and managing risks in families with a social worker.

The researchers recommend:

Open conversations between parents and professionals could be used to support safer sleep for babies who have a social worker.
These open conversations would need to acknowledge and discuss the reality of people’s lives in order to understand and address the motivation behind parental decisions and actions.
Conversations should include credible, trusted sources and sound evidence to explain how and why safer sleep practices aim to protect infants. Social pressures with regard to “good parenting” may act as barriers to open and frank conversations between parents and professionals.

The research finds in-depth conversations about safer sleep might best be delivered to families in receipt of social care by a practitioner, such as a Health Visitor, who can provide continuity of care and who has established a trusting relationship with them. Peer and family support networks are also important to reinforce messages and provide practical advice.

The report suggests professionals could engage parents to identify motivations and provide personalised support that is still consistent with national guidance, but that is based on the needs of individual families.

Such conversations need to be consistent with guidelines from NICE and The Lullaby Trust whilst also being sensitive to the needs and context of individual families. iHV supports the Safer Sleep campaign led by the Lullaby Trust which shines a spotlight on this important public health issue.

Read the report: Promoting safer sleeping for babies in high-risk groups in England