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

iHV launches ‘Health Visiting in England: A Vision for the Future’

The Institute of Health Visiting (iHV) is delighted to publish ‘Health Visiting in England: A Vision for the Future’, their evidence-based blueprint to rebuild health visiting services.

Developed in response to the government’s request for stakeholder engagement to inform their plans to refresh the health visiting model for England and the Healthy Child Programme, and taking into account the worrying loss of health visitors over the past 4 years, this publication sets out a new model of health visiting advising eight universal contacts and a particular focus on fifteen areas where health visiting can have a high impact on health outcomes.

Dr Cheryll Adams CBE, Executive Director of the Institute of Health Visiting, commented:

“Despite overall improvements in child health, England lags behind other countries on many key health outcomes: infant mortality reductions have stalled, our breastfeeding and obesity rates are amongst the worst in Europe, our immunisation rates are falling and health inequalities are seen across all indicators.

“The current status of health visiting is not serving families well, based as it is on universally delivered process outcomes which risk “ticking the box, but missing the point”. There remains a persistent gap between what the evidence tells us, and the profession aspires to achieve, and what is currently able to be funded and provided since the year on year cuts to public health budgets starting in 2015.

“Based on the evidence, we recommend that the universal offer in England includes three additional service “review points”, increasing the offer to eight contacts, with additional tailored support where needed, aligned primarily to fifteen High Impact Areas where health visitors can make the greatest difference to infant, children and family outcomes. But also recognising the value of health visiting in, for example, supporting the mother postnatally to manage on-going physical consequences of giving birth, supporting the family of a child who has a chronic and worrying health issue such as asthma, supporting families through a bereavement or working with a people within marginalised groups.”

Health Visiting in England: A Vision for the Future

The new iHV Vision for Health Visiting in England sets out an “upstream” public health response with action based on the principles of proportionate universalism. It seeks to address some of the limitations of the current 4-5-6 model, balancing the need for a population approach alongside a more personalised individual response.

In addition to renewed investment and revised workforce modelling, a plan for rebuilding the workforce will be needed to establish the workforce requirements to deliver a refreshed Healthy Child Programme and all levels of the health visiting service offer.

Dr Adams continued:

“National leadership by government is essential to set ambitious and binding national goals to reduce health inequalities for children in key public health priority areas.

“The health visiting service of the future needs to be built more closely around eight key elements to ensure the service is: evidence-driven, accessible, responsive, personalised, collaborative, fairer and effective. This will only be achieved with greater professional autonomy and a recognition of the importance of relationships at the heart of everything we do.

“We need action today, to support every child to have the best start in life and a ‘bright’ future.”

Download Health Visiting in England: A Vision for the Future

Follow and support #FutureofHV on social media.

Family homelessness crisis in England

The Institute of Health Visiting (iHV) comments on today’s publication of Bleak Houses: Tackling the crisis of family homelessness in England by the Children’s Commissioner.

iHV is saddened to learn that 124,000 children are now classed as homeless with some children needing to be housed in shipping containers. The councils blame this on a shortfall in their income of £159 million.

Dr Cheryll Adams CBE, Executive Director iHV, said:

“Whilst this sounds like a lot of money for the government to find, the actual costs of short, medium and longer term negative consequences for these children and their families on the fiscal purse will be very much more, including costs to the care, health, education, social security and criminal justice budgets.”

There are thousands of children in England who are living in homeless families, stuck in poor quality temporary accommodation, often with low prospects of finding something permanent. There are many others who are at risk of ending up homeless. This report shines a light on this homelessness crisis and shares the experiences of some of those children.

Go to Bleak Houses report

iHV supports launch of PIP UK’s Rare Jewels report

At the start of Infant Mental Health Awareness Week 2019, the iHV is delighted to support the launch of PIP UK’s report “Rare Jewels” on Specialised parent-infant relationship teams in the UK – published today, Monday 10 June 2019, at the APPG Conception to Age Two meeting in Parliament.

iHV Director, Dr Cheryll Adams, at launch of PIP UK’s Rare Jewels report at the APPG Conception to Age Two in Parliament

Alongside its focus on specialised teams, the report highlights the important role health visitors play in enabling good IMH:

“Health visitors play an important role in promoting parent-infant relationships as they have the opportunity to work with every family during this important period”.

“Nice Guidance for postnatal care states that assessment for emotional attachment should be carried out at each postnatal contact and home visits should be used as an opportunity to promote parent- or mother-to-baby emotional attachment”.

We are particularly pleased to see the value of specialist IMH health acknowledged. We look forward to strengthening this when we publish the findings from our own recent iHV survey into Infant Mental Health later this week.

The report, ‘Rare Jewels’, highlights the shocking lack of mental health provision for children aged 2 and under with data suggesting that 42% of Clinical Commissioning Group (CCG) areas in England CAMHS services will not accept referrals for children aged 2 and under.

The report makes several recommendations for local and national decision makers about how they could support the development of specialised provision. These include:

Collecting data disaggregated by age to ensure services are accessible to, and accessed by, children of all ages.
Ensuring there is clear accountability at a national and local level for commissioning mental health services to meet the needs of all children.
Creating a ringfenced transformation budget to support local investment in services for the first 1001 days of life.
Setting out clear implementation plans for how commitments to improve mental health provision will be realised for all children, including those 2 and under.

Governments across the UK have made commitments to increase early intervention, to improve children’s mental health and to close inequalities in outcomes.

The iHV supports this report’s call for them to provide focused and determined leadership and the investment required to translate their commitments into a reality to give every baby the best start in life.

Please do share the report with your networks and on any social media platforms using the hashtags #rarejewels #IMHAW19 #healthvisitors #infantmentalhealth. Please do also link to us using the handle @iHealthVisiting and @earlypotential

Go to PIP UK to download the Rare Jewels report

Government response to the ‘First 1000 days of life’ report

Today, the government has published the Command paper which sets out the government’s response to the Health and Social Care Select Committee report on ‘First 1000 days of life’, published by the House of Commons in February 2019.

The iHV supported the recommendations set out in the Health and Social Care Select Committee’s report ‘First 1000 days of life’, which makes a clear case for early intervention and a strengthened national strategy for the first years of life. The government’s response today and renewed commitment to ensure every child has the best start in life is welcomed – although today’s response is, in many ways, a holding response as we await the results of the Spending Review, the publication of the Prevention Green Paper and Inter-Ministerial group on early years (Leadsom Taskforce) which will hopefully fill the many gaps in detail.

Today’s response recycles a number of existing policy commitments to improve maternity services, support Troubled Families and address the inequalities in early language. In particular, we welcome the renewed commitment to the ambitions of the Maternity Transformation Programme “for maternity services across England to become safer, more personalised, kinder, professional and more family friendly; where every woman has access to information to enable her to make decisions about her care; and where she and her baby can access support that is centred on their individual needs and circumstances.” It also calls for all staff to be supported to deliver care which is women-centred, working in high performing teams, in organisations which are well led and in cultures which promote innovation, continuous learning, and breakdown organisational and professional boundaries. We would welcome a similar ambition for health visiting services.

We are concerned that there is a notable absence of new policies for children and families once discharged from maternity services and limited national levers to reverse the current unwarranted variation in the quality and quantity of support that families receive based on where they live, rather than their level of need.

Ultimately the success of any programme will rest on sufficient resources being allocated nationally through a cross-departmental plan, and the Spending Review funding settlement for local government will have an important impact on whether wider improvements in population health and prevention can be delivered. We will continue to advocate for a strengthened health visiting service as set out in our recent letter to the Treasury.

Go to Government response to the Health and Social Care Select Committee 'First 1000 days of life' report

Read iHV's response to Health and Social Care Select Committee’s report ‘First 1000 days of life’, February 2019

iHV supports RCN/QNI call for reinvestment into district nursing

The Institute of Health Visiting supports the RCN/QNI call for reinvestment into district nursing after a shocking loss of district nurses over the past 10 years.

A new report from the Royal College of Nursing (RCN) and Queen’s Nursing Institute (QNI) calls for urgent investment in District Nursing, as new figures show the number of District Nurses working in the NHS has dropped by almost 43 per cent in England alone in the last ten years. As a result, there are only some 4,000 District Nurses providing care for a population of around 55.8 million in England, a ratio of only one District Nurse for every 14,000 people. This compares with one GP for every 1,600 people.

The report, Outstanding Models of District Nursing, is published during the RCN’s annual Congress in Liverpool, where the 5,000 nursing staff attending include large numbers of District Nurses from around the UK.

Recent government strategy has called for more nursing care to be delivered in the community and in people’s homes in order to reduce patients’ lengths of stay in hospital and avoid unplanned admissions. The NHS Long Term Plan has identified the District Nursing service, which provides vital care for people in their own homes and in the community, as a key part of this strategy. However, government policies have not been followed by the investment needed to make the vision a reality, says the joint report.

Read full RCN news story