iHV welcomes Babies in Lockdown report

Charity collective, Best Beginnings, Home-Start UK and the Parent-Infant Foundation, publish a new report sharing families’ experiences of lockdown during pregnancy or with a baby.

Babies in Lockdown: listening to parents to build back better (2020), based on a survey of over 5000 families, highlights the chronic under resourcing of services for families, the inequalities in babies’ early experiences and its worsening forecast due to the COVID-19 pandemic. The report warns that many families with lower incomes, young parents and those from Black, Asian and minority ethnic communities, will have been hit hardest by the pandemic. The Babies in Lockdown Report shines a light on UK baby inequalities as charities call on Government to act now to avoid a “Post-COVID19 lottery”.

Dr Cheryll Adams CBE, Executive Director iHV, commented:

“The iHV welcomes this excellent report which lays bare just how challenging it has been for many parents during lockdown. It was distressing to read their stories and, in particular, how the most disadvantaged have felt the hardest impact of lockdown and lack of support. It is important that we listen to the voice of these parents and ensure that we are better prepared to meet the needs of young children and their families as the pandemic continues. We support the report title, we now need to build back better for infants and their families and this will include ensuring that all families receive support from the health visiting service during this crucial stage of their parenting journey”.

The report tells us that:

COVID-19 has affected parents, babies and the services that support them in diverse ways.
Families already at risk of poor outcomes have suffered the most.
Without action, the pandemic could cast a long shadow on the lives of some babies.

The Babies in Lockdown: listening to parents to build back better (2020) report makes three policy calls for the UK Government:

A one-off Baby Boost to enable local services to support families who have had a baby during or close to lockdown.
A new Parent-Infant Premium providing new funding for local commissioners, targeted at improving outcomes for the most vulnerable children.
Significant and sustained investment in core funding to support families from conception to age two and beyond, including in statutory services, charities and community groups.

Read Babies in Lockdown: listening to parents to build back better (2020) full report

Read Babies in Lockdown Executive Summary

Go to Babies in Lockdown website for more info

iHV comments on UCL survey on impacts of COVID-19 on Health Visiting in England

According to a new survey from University College London (UCL), health visitors are concerned that the needs of children have been missed due to staff redeployment to support the COVID-19 workforce and increased caseloads.

Download The impacts of COVID-19 on Health Visiting in England - first results

The UCL survey of 663 health visitors in England, conducted between 19 June and 21 July 2020, found that 41% of respondents in teams that lost staff had between 6 and 50 team members redeployed between 19 March to 3 June 2020.

In approximately 10% of teams, which experienced a loss, this was a redeployment of at least half of their staff. Few teams (9% among those with staff redeployed) gained additional staff to fill the gaps. This meant that 253 respondents (38%) had their caseload increase, some with an increase of 50% or more, and 73% of those that experienced a change reported that their caseload had not returned to its usual size.

Dr Cheryll Adams CBE, Executive Director iHV, commented:

“The interim results of this research into the impact of redeployment of health visitors by University College London confirms all the anecdotal evidence already sent to the iHV by health visitors. Health visitors should never have been redeployed, instead their time should have been spent on reaching the most vulnerable families during lockdown and checking in on all other families. I don’t believe we yet fully know the impact of that period on children and families, but this research confirms that it was very significant for many families. Furthermore, there were significant impacts on the health visitors themselves, as those remaining strived to provide redesigned services and to reach the most vulnerable families, and those redeployed worried about the families they had left behind without opportunity for necessary handovers. I find the feedback on how the health of health visitors was impacted particularly distressing, this should not have been allowed to happen.

“Developmental reviews have now been delayed for more than four months and that too will mean that developmental delays are being missed and this could impact children for the rest of their lives. The already very diminished health visiting service in some areas of the country will be struggling to catch up whilst also juggling the challenge of maintaining their personal safety, and that of families. If we do face a second wave of COVID-19, health visitors must not be redeployed again. Instead, an urgent workforce plan is needed to rebuild numbers in the profession which are at their lowest for very many years and, alongside that, tackle the huge inequities in service delivery across England which have opened up over the past five years. It is not right that whilst children in some areas of the country continue to receive a reasonable service, children in many other areas now only receive a skeleton service, made even worse now by the challenges of service delivery during the COVID-19 pandemic.

“The first years of life lay down the foundations for our future health and wellbeing – get it right then and children will thrive and achieve at school and in the workplace; get it wrong, as we are now in England, and governments for many years to come will be paying for the consequences. The critical value of health visiting services is understood and invested in by the Scottish, Welsh and Northern Ireland governments. However, in England, it is not OK that an unwarranted variation of service quality has been allowed to open up as health visiting numbers continue to be allowed to plummet. I hope that the interim findings of this research will lead to prompt action. They have been published early as the researchers were so concerned by what they found.”

Dr Gabriella Conti, Associate Professor (UCL Economics and Institute of Fiscal Studies) who led the survey, said:

“Whilst all families are impacted by COVID-19, the most detrimental effects are felt by those who are already disadvantaged – in particular, our most vulnerable infants and children whose needs are often hidden from sight.

“Increased caseloads for a significant proportion of health visitors, along with reports of a lack of PPE for home visits, has created a lot of additional stress and anxiety, during a time of great uncertainty and difficulty.”

The researchers make a number of policy recommendations, including for:

Health visiting services to be reinstated (where not already happening) to provide vital support and a safety-net for children, with appropriate measures put in place, including the use of PPE, to reduce the spread of the virus.
An evaluation of the use of virtual, non face-to-face service delivery methods to determine their effectiveness for identification of vulnerabilities and risks, impact on child and family outcomes and reducing inequalities to inform future digital change.
A clear workforce plan to ensure that the health visiting service has sufficient capacity to manage the backlog of missed appointments, as well as demand for support due to the secondary impacts of the pandemic.
A proactive plan to ensure staff wellbeing during the restoration of services.

Research assistant Abigail Dow (UCL Economics) said:

“A cross-government strategy is needed to reduce inequalities and “level-up” our society. This will require investment to strengthen the health visiting service which plays a crucial role in the early identification and support of the most disadvantaged families.”

The survey, supported by the Institute of Health Visiting, was carried out using the online survey platform Qualtrics. Participants (98% female, 88% White British or Irish, and average age 50) were obtained with consent from the Institute of Health Visiting database. Data collection is still ongoing and a full report will be released later this year.

iHV welcomes Children’s Commissioner’s new report “Best Beginnings”

The Children’s Commissioner for England has published a report looking at the provision of early years services for children across the country, alongside a warning that many nurseries are at risk of closure, hitting the life chances of some of the most vulnerable children and holding back the economic recovery following lockdown.

The report, ‘Best Beginnings’, is an in-depth examination of early years provision in England. It describes a system that is disjointed and often failing to target those disadvantaged children with development problems who most need early help.

It comes amid a recent warning from childcare providers that one in four nurseries and pre-schools fear closure within the year, rising to one in three in the most disadvantaged areas, as a result of the coronavirus lockdown.

Dr Cheryll Adams CBE, Executive Director iHV, commented:

“Best beginnings is a powerful and very well researched report from Anne Longfield, the Children’s Commissioner and her team. It recommends a strengthened holistic, cross-government approach to ensuring that every infant is supported to meet its full potential, whether through strengthened community services, including health visiting, or a strengthened childcare/nursery offer.

“I particularly liked the starting point: There are certain things that every baby needs as the foundations for a healthy, happy life:

Loving, nurturing relationships with parents and carers

A safe home free from stress and adversity

The right help to develop good language and other cognitive skills

Support to manage behaviour and regulate their emotions

Good physical and mental health and access to healthcare”

“Helping parents achieve this for their infants is the essence of health visiting.”

The report shows the need for an overhaul of the early years system in England. It details how too many children, particularly those growing up in disadvantaged families, are already behind by the time they start formal education. Last year, 29% of five- year-olds in England were not at the expected level of development by the time they started school, including 45% of children receiving Free School Meals. In Middlesbrough, 38% of children are not achieving the expected level of development aged 5, while in Dudley and Sandwell it is 35% of children.

The report sets out how starting school behind can undermine children’s life chances. The Commissioner’s office analysed data on all children in England who had not met the expected level on half of their early learning goals at age 5 and tracked them through to the end of primary school. These children were:

five times as likely to end up being excluded by age 10
twice as likely to have had contact with children’s social care by age 11
three times more likely to be struggling with reading at age 11
four times more likely to be struggling with writing at age 11.

Recent research also shows these children are more likely to leave school with no GCSEs, more likely to suffer some form of mental ill health and more likely to be obese.

The Children’s Commissioner is calling for a new ‘Best Beginnings’ early years investment plan, ranging from Children and Family hubs to midwives and health visitors, to tackle these problems at the beginning of a child’s life rather than waiting until crises develop in later years. While some foundations of an excellent early years service are already in place, the Children’s Commissioner is urging the Government to bring together and turbocharge these services into one system which provides first class provision that works for families and ensures that all children, including the most disadvantaged, get the best possible start in life.

The Children’s Commissioner makes a number of recommendations including:

An emergency recovery package for the childcare providers whose finances have been worst affected by Covid-19. Government should also reconsider the design of Universal Credit which makes it hard for lower earning families to get help with childcare, as parents have to pay costs upfront and then wait to be repaid.
An expanded offer of 30 hours free childcare and early education for all children aged two, three and four, and 15 free hours for all one-year-olds, so that early years education is seen as part of ordinary life, in the same way that school is.
A cross-government ‘Best Beginnings’ strategy led by a Cabinet Minister for the Early Years. This would set out how a revitalised and extended Healthy Child Programme, the Early Years Foundation Stage, Children and Family Hubs, antenatal services and the Troubled Families Programme would work together.
A Family Guarantee of support for under-fives and their families delivered by health visitors, early help and Troubled Families workers, family nurses or family support workers based in Family Hubs.
A national infrastructure of Children and Family Hubs. These would be a centre point of support for children and families and act as a gateway to multiple services. Each hub would be a base for universal services so that every child is reached.
A Government review of early education and childcare funding to ensure it is working as effectively as possible to help children and families who need it most.
A single system for supporting families with early years education and childcare, with fees charged in relation to families’ incomes as they are in Sweden and Norway.
A national workforce strategy for the early years, focusing on staffing across existing health, local government and early years settings.
Better sharing of data between different services, so children who need help do not fall through the gaps or go unidentified. This should include more effective use of a child’s NHS number and Unique Pupil Number so it is possible to match children in different databases.

Download - Best Beginnings: A proposal for a new early years guarantee to give all children in England the best start in life

Download - Best Beginnings:
Technical report - Predicting children’s outcomes at the end of primary school based on their early years foundation stage profile results

iHV welcomes new report by the Child Safeguarding Practice Review Panel

A new report by the Child Safeguarding Practice Review Panel calls for the Government to develop new tools to help prevent the sudden unexpected death of infants (SUDI).

The independent panel of experts reviews serious child safeguarding incidents, when children have died or suffered serious harm, to learn how to improve the safeguarding system.

While the overall numbers of babies dying from SUDI are decreasing, a worrying number of deaths have been notified to the panel as serious child safeguarding incidents. Between June 2018 and August 2019, the deaths of 40 babies from SUDI were reported to the panel. Most of whom died after co-sleeping in bed or on a chair or sofa, often with parents who had consumed drugs or alcohol.

Dr Cheryll Adams CBE, Executive Director iHV, commented:

“The loss of every baby is a tragedy for their parents and the services supporting them, so it is reassuring to see the number of babies dying from SUDI continues to fall. This suggests that the safe sleeping messages are generally getting through. However, as this report makes clear, more of these deaths might still be prevented if all parents had the right support when they were struggling with multiple issues – information alone is not enough. Again, this makes the case for health visiting services to be strengthened so that the support needs of all parents are recognised early and that they are given timely and appropriate help.”

The review reveals families with babies at risk of dying in this way are often struggling with several issues, such as domestic violence, poor mental health or unsuitable housing. It found that these deaths often occur when families experience disruption to their normal routines and so are unable to engage effectively with safer sleeping advice. Due to coronavirus (COVID-19) and the associated anxieties about money, social isolation and mental health issues, disruptions that led to the deaths of these infants may be more prominent at present.

To address this, the panel is calling for local areas to reduce the risk of SUDI by incorporating it into wider strategies for responding to social and economic deprivation, domestic violence and parental mental health concerns. This should be backed up by new government tools and processes to support frontline practitioners and local safeguarding partners to make these changes.

Download Out of routine: A review of sudden unexpected death in infancy (SUDI) in families where the children are considered at risk of significant harm (July 2020)

iHV responds to Petitions Committee report: impact of COVID-19 on maternity and parental leave

The Petitions Committee has today launched its landmark report calling on the Government to extend parental leave and pay for all new parents affected by COVID-19.

More than 226,000 people have signed an e-petition calling for the Government to extend maternity leave by 3 months with pay in light of COVID-19. The committee received over 69,000 responses with people sharing their experiences and views on the Government’s response and on the actions they think need to be taken.

But the Government’s response to this petition to date has been to turn down petitioners’ requests for more time. The Committee has heard from new parents who have found that their jobs are at risk as they are unable to find childcare, from parents whose mental health has been severely affected, and from parents who are desperate for help and support. In addition, Dr Cheryll Adams appeared before the House of Commons Petitions Committee in May to talk about the petition – she contributed some evidence and raised the profile of the work of health visitors during COVID-19 – see news story here.

Dr Cheryll Adams CBE, Executive Director, iHV, commented:

“This enquiry has demonstrated government and democracy at its best, with the views of the population, in this case new parents, being truly listened to. Young families have received little attention during the response to the COVID–19 pandemic but the Institute has reported that their needs, as a result of lockdown, could form a secondary pandemic if not addressed quickly.

“As families start to surface again, we are now hearing evidence of the impact of the past three months in lockdown on families, with an increased incidence of safeguarding issues (more domestic violence), more infants going into care. Health visitors are also reporting an explosion of mental health issues, especially for our most vulnerable families including those who have fallen into poverty due to job losses, or who may have had children with special needs or prematurity. Many others are worrying about their return to work as evidenced by the enquiry. The loss of easy access to the normal support services, and to opportunities to maintain their social and emotional wellbeing through meeting with family and friends has been profound.

“We recommend that the Government listens to the overwhelming evidence gathered from parents and experts in the early years by this enquiry committee. It must act now to provide additional support, especially to those needing to return to work in the next few weeks/months, but also respond to the clear evidence that this stage of everyone’s life trajectory needs to be taken much more seriously by the Government. Ultimately all the evidence is clear, doing so will lead to many future financial and social benefits for the country as a whole.

“An urgent first step is to do a workforce review of the health visiting service, provide new funding to replace the huge numbers of health visiting posts which have been allowed to be lost since 2015, and address the inconsistencies in the health visiting services that parents can access up and down England. The Institute has already published its own Vision for how this should be done.”

The report finds that there are many more areas where the Government needs to consider taking urgent action, including access to free dental treatment for new mothers, access to rapid COVID-19 testing for parents with babies in neonatal care, and the extension of protections for women against losing their jobs as a result of being pregnant or a new parent.

Key findings and recommendations made in the report include:

New parents have missed out on crucial support, the lack of which could have a huge impact on their mental health and that of their children, with resulting impacts on the NHS and the UK economy
The Government should extend parental leave and pay for all new parents affected by the pandemic. This includes maternity leave, shared parental leave and adoption leave
The Government should publish clear new guidance for employees and employers on supporting pregnant employees and those returning from parental leave that explains clearly their options and responsibilities
The Government should consider extending the period in which pregnant women and new parents may bring claims before the employment tribunal to 6 months from dismissal in light of current challenges posed by Covid-19
Free dental care is an important benefit that most pregnant and new mothers have been unable to access as the result of the pandemic. The Government should extend maternity dentist provision for new and expectant mothers affected by the pandemic for at least six months
The Government should review the provision of health visitor services in light of Covid-19 and consider funding increased numbers of health visitors and other allied professionals, to ensure that vulnerable families are identified and given the support they need
The Committee strongly urges the Government to follow the science and stay alert to how the Government supports new parents so that the effects of the pandemic do not continue to impact families for years to come

Read shorthand story: How has maternity and parental leave been impacted by coronavirus? We look at the impact of COVID-19 on new and expectant parents and their children

Read full report: House of Commons Petitions Committee - The impact of COVID-19 on maternity and parental leave

Child scalding during COVID-19

Since lockdown measures were implemented towards the end of March, the Burns Centre at Birmingham Children’s Hospital, Birmingham, UK, has received a 30-fold increase in the number of scalds directly resulting from steam inhalation.

On average, the unit admits two patients per year with scalds related to steam inhalation. Over the past month alone, they have admitted six children with burn injuries due to this mechanism, with the youngest child aged 2 weeks, and the most severe case involving 8% of the child’s total body surface area, requiring excision and skin grafting. The mechanism is most frequently accidental spillage of boiling water from a bowl or from a kettle. Children have occasionally been left unsupervised.

The team surveyed Burns Services across England. With an 86% response rate, they found that 50% of centres have had an increase in scalds relating to steam inhalation. This correlated with regions of England with higher prevalence of COVID-19 (London and South East; West Midlands; North West). Two-thirds of centres reported an association with Asian ethnicity (Indian, Pakistani, Bangladeshi, or Other).

Steam inhalation is traditionally used as a home remedy for common colds and upper respiratory tract infections. The evidence base of the practice is weak, with unproven theories that the steam loosens mucus, opens nasal passages, and reduces mucosal inflammation, or that the heat inhibits replication of viruses. Social media and home-made tutorials from unverified sources have a role in misleading parents into practising this dangerous habit.

Scald injuries are the commonest cause of burns in children. Steam inhalation is a hazard to children. Resulting scalds can ultimately lead to hospital admission, surgery, and life-long disfigurement.

Parental education is paramount to preventing these injuries. Clinicians should actively discourage steam inhalation and educate parents about alternative treatments for their child.

Go to the Lancet to read Steam inhalation and paediatric burns during the COVID-19 pandemic

Shocking gaps in emergency preparedness for Europe’s babies

During #BreastfeedingCelebrationWeek, the first European report on infant and young child feeding policies and practices was launched yesterday. It compares 18 countries and identifies the considerable improvements they need to make in supporting mothers who want to breastfeed.

The COVID-19 pandemic has shown how important it is for countries to protect their citizens from illness. Babies who are breastfed have better health and resistance to infection, and most mothers want to breastfeed. Yet many European mothers stop or reduce breastfeeding in the early weeks and months, and bottle feeding is prevalent, due to inadequate support from health systems and society.

This new report, Are our babies off to a healthy start?, compares the implementation of WHO’s Global Strategy for Infant and Young Child Feeding by 18 European countries. The comparisons show clearly that inadequate support and protection for breastfeeding mothers is a Europe-wide problem. The health of babies, mothers and whole populations loses out as a result. However, countries do differ considerably. Turkey rates highest overall; the five countries with the lowest scores belong to the European Union.

The scope of the assessment is wide-ranging, with ten policy and programme indicators, including national leadership, hospital and community practices, marketing controls on breastmilk substitutes, health professional training, emergency preparedness and monitoring. There are also five feeding practices indicators, such as exclusive breastfeeding for 6 months, a WHO recommendation.

The indicators with the poorest overall scores are national leadership and, shockingly, emergency preparedness, where the UK scored 0/10.

Read the summary report published in the International Breastfeeding Journal

Read the full report - Are our babies off to a healthy start?

iHV welcomes RCPCH State of Child Health 2020 report

iHV welcomes today’s publication of the Royal College of Paediatrics and Child Health (RCPCH) report, State of Child Health 2020, the largest ever compilation of data on the health of babies, children and young people across all four UK nations.

The report shows that for many measures of children’s health and wellbeing, progress has stalled, or is in reverse – something rarely seen in high income countries.

Across most indicators, health outcomes are worse for children who live in deprived areas. Inequalities in some outcomes have widened since the last State of Child Health report in 2017. Progress has also been seriously affected by deep cuts to local authority budgets – used to finance public health initiatives and community services.

Commenting on the launch of the State of Child Health 2020, Dr Cheryll Adams CBE, Executive Director of the iHV, said:

“The results of this report make very sad reading. They build on the evidence base from the recent Marmot 10 years on report and our own latest published research with the health visiting workforce. The State of Child Health 2020 recommendations are excellent and now need to be implemented by ministers. You don’t get a second chance with children – those most disadvantaged today, will be drawing disproportionately on health and wellbeing services tomorrow.

“If the government has any ambition to leave the country in a better place than it was in when they picked up the reins, they must listen and respond quickly to all these recent reports. Our most vulnerable citizens are becoming more vulnerable and only government can change that. Children really can’t wait. Already, many children face uncertain futures as their families haven’t received vital support during their early years.

“It is positive to see health visiting identified as a solution in the RCPCH report. Yes, it is a solution, but very urgent action is required to reinvest into public health before the implications of not doing so become even more stark.”

State of Child Health 2020 brings together 28 measures of health outcomes, ranging from specific conditions – such as asthma, epilepsy, and mental health problems – to risk factors for poor health such as poverty, low rates of breastfeeding, and obesity.

The authors make a number of policy recommendations for each nation. For England, these include:

Introduce a cross-departmental National Child Health and Wellbeing Strategy to address and monitor child poverty and health inequalities.
Restore £1 billion of real-terms cuts to the public health grant for Local Authorities.
Ensure future investment in public health provision increases at the same rate as NHS funding and is allocated based on population health needs.
Implement in full commitments from the prevention green paper, Advancing our health: Prevention in the 2020s.
Implement commitments to provide a Youth Investment Fund, with protection of the committed £500m funding.
Provide health-based support for children throughout education, including funding for increased numbers of school nurses and school counsellors.
Provide renewed investment in services for children and families, which support the child’s school readiness.
Ensure that health visiting services are protected, supported and expanded with clear and secure funding.

Go to RCPCH State of Child Health website for more information

iHV responds to NSPCC survey findings

iHV responds to the results of the latest NSPCC survey which finds that mothers report lack of consistent care during pregnancy and post-birth – only 6% of mums could recall seeing the same health professional in health reviews that take place during pregnancy and up to their child’s 1st birthday.

The NSPCC survey of over 2,000 mothers with children aged 1 to 3 in England about their experiences of health reviews revealed:

nearly a quarter saw a new person each time
over a quarter had a letter, phone call or text message instead of a face-to-face visit
40% said their health professional didn’t establish a relationship where they could share concerns about their wellbeing
over a quarter reported rarely being asked about their mental health.

Commenting on the NSPCC survey, Dr Cheryll Adams CBE, Executive Director of the iHV, said:

“The NSPCC findings match those from our own recent survey of 1000 parents with Channel Mum. It is unacceptable that mums, at one of the most vulnerable times of their and their infants’ lives, aren’t getting access to consistent and high quality advice from a trusted health visitor as they should. The cuts to public health budgets have bitten deeply. It’s not only health visitors who have been lost, it’s also child health clinics, meaning that mothers will turn to the internet for advice which may be reliable, but very often isn’t, it may even be dangerous.”

The results of the NSPCC survey closely match iHV’s recent publication ‘What do parents want from a health visiting service?‘ survey report which found that parents want:

Continuity of health visitor – someone who knows them as an individual and who they can trust
Equity of access to support – receiving all mandated contacts and extra help when needed, regardless of where they live

Dr Adams continued:

“Our annual State of Health Visiting survey findings, published last week, demonstrated that 80% of mothers now don’t formally see a health visitor after their 6-8 week contact – so most are not receiving the five checks mandated by government by a health visitor, if at all. Only 34% reported being able to offer an antenatal contact to all or most families. Postnatal depression will inevitably be missed and much more. Health visitors are doing their very best, but are now mostly working with caseloads that are so large they are unsafe.”

Download State of Health Visiting in England: Results from a survey of 1040 practising health visitors

Dr Adams concluded:

“It is a national scandal that our youngest and most vulnerable citizens and their parents continue to be subjected to ever disintegrating levels of state support. For the health visitors themselves, it is devastating to no longer be able to provide the services which they know families need.”

Ahead of the upcoming budget and spending review, iHV joins NSPCC’s call to urge government to invest in the public health grant so families get the care they need – Fight for a Fair Start campaign.

Health visitors’ fear for children’s wellbeing due to relentless service cuts

Public health budget cuts have left health visiting services unable to offer the minimum level of support in many areas

Many health visitors across England have been robbed of their ability to protect vulnerable families by devastating cuts to public health budgets. That is the headline finding of an annual survey of health visitors in England, published today by the Institute of Health Visiting (iHV), alongside calls to ring-fence new funding for the profession.

Released just days after the Duchess of Cambridge highlighted the importance of a secure childhood for future health and wellbeing, the iHV State of Health Visiting survey indicates that those professionals best placed to help children get the best possible start in life lack the resources to do so.

Official figures indicate that around one in five health visitors were lost between 2015 and 2019 – the full-time equivalent of 18% of the workforce. This is due to public health budget cuts and the failure to protect health visitors’ preventative role by many cash-strapped local authorities, after health visiting commissioning moved from the NHS to local authorities in 2015.

The consequences can be devastating, with 48% of health visitors saying they feel so stretched that they fear a tragedy where they work.

As one health visitor told the iHV: ‘Larger caseloads and fewer staff mean families are not getting a tailor-made service to meet their needs. Vulnerable children are slipping through the net.’

Almost a third of health visitors report they are now responsible for between 500 and over 1000 children. Meanwhile, the iHV considers the optimal maximum to be 250 children in order for health visitors’ work to be fully effective, less in areas of high vulnerability. Consequently, 58% of health visitors are working long hours and feeling ‘worried’, ‘tense’ and ‘anxious’.

One health visitor said: ‘I have taught myself to become numb to what is happening within health visiting – as a coping mechanism.’

The iHV is calling for urgent action to address this crisis – before more damage is done.

Dr Cheryll Adams CBE, Executive Director of iHV, said:

“It is absolutely unacceptable that many families are struggling through the significant demands of early childhood without the vital support that they need and are entitled to through the government’s flagship Healthy Child Programme. Indeed, the government’s pledge to give every child the best start in life has been left in tatters after year-on-year cuts to the public health grant, which have dismantled the health visiting services designed to support them in many areas.”

The Institute is calling for:

New ring-fenced cross-government funding for early intervention and the health visiting profession.
Statutory protection for the health visitor role in leading the delivery of the Healthy Child Programme and for health visiting to be returned to statutory regulation.
Workforce modelling and a new workforce strategy for health visiting.
A new focus on improving the quality of services which health visitors can offer families, regardless of where they live.

Dr Adams continued:

“Our survey indicates that health visitors have seen rising demand for support from families, almost certainly related to austerity. Meanwhile, they themselves have battled with ever increasing caseloads, due to the fall in health visitor numbers. It was particularly disturbing that one in four health visitors told us that they are seeking professional help from a GP or elsewhere, due to the demands of their job.”

“Health visitors worry about children being at risk and there is no doubt that their stress levels directly related to them feeling unable to deliver the quality of service that they know they can – and should be able to – offer, as well as the fear of children’s needs being missed. Our children are our future. They deserve much better than this.”

The headline findings of the iHV State of Health Visiting survey are:

Only 21% of health visitors rated the quality of care that they can now offer families as ‘good’ or ‘excellent’.
48% of health visitors said they feel so stretched that they fear a tragedy where they work. This is up from 23% in 2015, which even then suggested a profession under pressure.
29% of health visitors are now responsible for between 500 and more than 1000 children.
While in 2015, 65% of health visitors were able to offer continuity of carer to all, or most, families, by 2019 that number had fallen to just 35%. Continuity of carer has been shown to be greatly valued by parents and health visitors, as it allows them to build a trusting relationship and gives parents confidence to ask for help.
58% of health visitors reported that they are working longer hours and are feeling worried, tense and anxious.
36% of health visitors said they would leave health visiting if they could.
Despite being mandatory, only 34% of health visitors reported that they were able to offer an antenatal contact to families.
81% of health visitors reported that they are not conducting 12-month reviews of children and 90% were not completing the 2 to 2.5-year review. This directly contradicts government’s call to reduce the language gap. These essential checks are most frequently delegated to more junior members of staff. This means that many families will not see a health visitor after their infant is 6-8 weeks old – especially with the closure of many child health clinics alongside the cuts to health visiting numbers.

Download State of Health Visiting in England: Results from a survey of 1040 practising health visitors

Find out more about Our Vision for Health Visiting