Yesterday, the House of Commons Petitions Committee published the Government’s response to the Committee’s first report on the impact of the COVID-19 pandemic on new parents. The response is available here.

The Committee’s report focused on the additional pressures that COVID-19 and the pandemic response have brought for new and expectant parents, and called for: strengthened perinatal mental health services; increased in-person visits by health visitors to new parents; a review of monitoring and enforcement activity relating to employers’ health and safety obligations to new parents; legislation on extended redundancy protections for new and expectant mothers; and a review into the funding and affordability of childcare

The Government’s response states:

“We understand that the pandemic and the pandemic response have involved a significant amount of upheaval for new parents, including through changes or delays to services, and national lockdowns presenting barriers to support and care from friends and relatives. The first 1,001 days from conception to the age of two are critical: they set the foundations for an individual’s cognitive, emotional and physical development through the early years and growing up well. We continue to support giving every child the best start in life, including through building back better from the COVID-19 pandemic. In October 2021, an additional £500 million was announced through the Budget for Start for Life and family help services [this includes £200m for the Supporting Families Programme for children of all ages]. This represents an important step in implementing the vision set out in The Best Start for Life: a Vision for the 1,001 critical days, published by the Early Years Healthy Development Review led by Dame Andrea Leadsom.”

At the iHV, we support the Petitions Committee’s conclusion that, whilst this investment is an important first step and a welcome commitment to the ‘First 1,001 Days’, this does not go far enough. The Committee’s response states:

“We welcome the long-term vision of the Government’s Best Start for Life review, but to date COVID-19 recovery funding aimed at children aged under 2 appears to have been unjustifiably neglected compared to the funding made available for older children. As we emerge from the pandemic, the Government must ensure it invests proportionately in the infrastructure which supports these families.”

The iHV is working closely with the Parent-Infant Foundation and many other leading organisations who are calling on the Government for a fully funded COVID-19 recovery plan for babies, young children and families.

Alison Morton, iHV Executive Director commented:

“There is no denying that the impact of the pandemic on babies, young children and families has been wide ranging, and disproportionately affects those who were already disadvantaged. Whilst the Government’s recent commitment of £300m for the Start for Life Offer is a welcomed step in the right direction, it doesn’t go anywhere near far enough to address the scale of unmet need and intensity of support required.

“Left unaddressed, the burden of vulnerability and early adversity is cumulative and may last a lifetime for some children. But, in a world of seemingly intractable challenges, there is hope – meaningful prevention, early intervention and care promises better health and wellbeing across generations. Inequalities are not inevitable; they are within our gift to change if we have the will and the means to tackle them.

“We therefore join with others in calling for a clear COVID-19 recovery plan for babies, young children and families at the scale of intensity required, and with the investment needed, to put this right. This includes tackling the workforce ‘elephant in the room’. The current workforce shortages in health visiting have been ignored for far too long, and their impact is being felt across the health and social care system and by parents who face the brunt of short-sighted policy making. We need more health visitors, and we need to start rebuilding this vital infrastructure of support for families now.”

We are grateful to the support of more than 700 leading children’s organisations who have supported our call for investment in health visiting. The Parent-Infant Foundation has highlighted three areas where they feel that the Government’s response is insufficient:

  • The Government is diminishing the impact of the pandemic on our babies
  • Disparities in recovery funding are inconsistent with Government’s own acknowledgement of the importance of the first 1001 days
  • More must be done to strengthen our health visiting services.

 

 

 

Health visitors across the UK have expressed their widespread disappointment at the Government’s dismissive response to a recent petition calling for reinvestment in health visiting. The petition was set up by health visitors in Hampshire who were concerned that the proposed cuts to their service, and many other local authorities in England, would knowingly cause harm to babies and young children, and leave families without the support they need.

The Government’s response to this petition has been labelled a ‘whitewash’ by many as it fails to take these concerns seriously, stating: “Local authorities are best placed to make decisions for their communities… Local delivery models vary, as services are tailored to meet local need… We do not advocate a specific health visitor staffing number or case load. This is because it should be led by health needs of a population.”

Lesley Tarling, the health visitor in Hampshire who set up the petition, says:

“I’d like to thank the Government for their response to our petition. However, it is disappointing that the core question in our petition remains unanswered. Funding cuts have inevitable consequences, health provision to the young will be irreparably affected. Health issues will be missed, and Adverse Childhood Experiences accentuated”.

Has need gone down? Do some areas not need a robust health visiting service? On the contrary, the evidence is clear that vulnerable babies, young children and families live in every postcode in the county, and many of the challenges they face are not socially correlated. With widening inequalities in England, a poor state of child health, more families tipped into vulnerability due to the pandemic, and a backlog of children not seen face-to-face, health visitors are needed more than ever to ensure that babies and young children at risk of poor outcomes are identified, and that families are supported at the earliest opportunity.

It will be a while before we know the full impact of the pandemic, what is clear is that need has definitely not gone down. Many health visitors are reporting that they are concerned that they are only reaching the “tip of the iceberg”, with research highlighting increased demand across the breadth of health and social needs.

Health visiting entered the pandemic in an already depleted state following a 31% reduction in health visitors in England since 2015, with more local authorities planning further cuts due to budget deficits. 80% of health visitors now manage caseloads above the recommended number of 250 children per health visitor (almost one-third have more than double this amount, and 12% have over 700 children). As a result, families face a postcode lottery of support – it is clearly impossible for a single health visitor to provide the personalised care that parents want, and that the Government recognises as central to effective outcomes. With such unmanageable caseloads, no amount of delegation or ‘digital light touch offer’ can detract from the key governance issue that a single health visitor will be responsible for overseeing, planning, reviewing and supervising the care of such large numbers of children.

Should local areas decide? Whilst there are some excellent examples of effective services, the petition response ignores the current “Wild West” of health visiting which cannot be ignored. The Government’s own Early Years’ review reported that families are being let down by poor quality services in some areas with findings published in March highlighting: “workload pressures… meant it was hard for dedicated professionals and volunteers to support families in the way they wanted to and, sadly, the Review also heard examples of instances where families felt let down by the services they received”. 

What would babies and young children say? They are citizens with their own needs and rights that are easily overlooked without the universal safety net that a robust health visiting service provides.  Sadly, 285 children were killed or seriously harmed in the first 6 months of lockdown; of these, 35.8% were babies under 1-year of age. Babies under the age of one also remain at the highest risk of homicide compared to any other age group. Our most vulnerable members of society cannot ask for help, they rely on others to advocate for them. Whilst many parents can advocate on behalf of their baby or young child, sadly in some instances, parents cannot care for their child and lack the agency to reach out for help when needed. It is therefore vital that an effective, statutory, universal health visiting service is provided in all areas – this cannot be left to chance.

When we recently challenged these serious incident and child death figures, we were offered the platitude that although the figure had increased this year, it was not extraordinary as it had been almost as high in 2018/19!!! Does this make it acceptable? Each one of these children represents another “Baby P” or “Victoria Climbié” – they have paid the ultimate price and been let down the most. We need to do better, not worse. Yet, the health visiting service intended to identify and support vulnerable babies and young children faces ongoing cuts, a shift to non face-to-face contacts, and outcomes reduced to ‘bean counting’.

We cannot say we didn’t know – the Government’s lack of action sends a powerful message that the current state of affairs is acceptable.

Look beyond the misleading and superficial process outcome data: The Government’s petition response states that:

“most recent data available on health visitor service delivery in England shows that a high proportion of infants received mandated health reviews in 2019/20:

  • New birth visits completed: 97.5%
  • Proportion of infants receiving a 6 to 8 – week review: 85.1%
  • Proportion of children receiving a 12 – month review: 77.0%
  • Proportion of children receiving a 2 -2 ½ review: 78.6%.”

It is important that we keep the needs of the child at the centre and are not misled by this ‘whitewash’ of process outcome measures which overlook important quality metrics. What this data does not show:

  • A postcode lottery of health visiting support with some families reporting that they haven’t seen a health visitor face-to-face for over a year.
  • Many of these reviews are not completed by qualified health visitors now. In a recent survey by the Institute of Health Visiting, only 17% of 1-year reviews, and 10% of 2-year reviews, were completed by a qualified health visitor.
  • To cut costs, some areas are now completing these important universal assessments with a postal or telephone contact despite evidence warning that this practice is unsafe and introduces unacceptable risks – it ticks the box, but misses the point: Needs change over time – it is therefore imperative that ALL 4 mandated reviews that children receive between birth and 2.5 years are completed face-to-face (we need to get this right, it is such a minimal ask). It is clearly impossible to complete an accurate holistic assessment of a baby or young child without physically seeing them, the subject of the assessment. The lack of national standards for these reviews and the Government’s knowing acceptance of the dangers inherent in this ‘local flex’ is causing harm; vulnerable children and serious health conditions will continue to be missed unless addressed. Virtual contacts have a place in a modern healthcare system, but they should not be used for universal reviews and should only be used when it is safe to do so and they enhance quality of care.
  • Whether the contacts actually made a difference: The universal contacts are a  gateway into health visiting support and will only be effective if the service has sufficient capacity to act on identified needs and provide the intensity and quality of support needed to make a difference.

Investment in babies and young children and preventative public health: The petition response states that the public health grant to local authorities in England will increase from £3.279 billion in 2020/21 to £3.324 billion in 2021/22, an increase of 1% in cash terms. However, this represents a cut in real terms. Public health grant allocations have fallen in real terms from £4.2 billion in 2015–16.  On a per head basis that equates to a 24% cut since initial allocations were made in 2015–16 (Health Foundation analysis).

At a minimum, the Government should restore the grant to 2015/16 levels by investing an extra £1 billion a year and then ensure that the grant keeps pace with growth in NHS England’s spend and covers the costs of implementing the Early Years’ review recommendations in full. We have estimated that in order to rebuild the service and ensure that all families receive the support they need, an additional 5,000 health visitors are needed in England.

This situation is reversible but needs political will. Children’s needs should now be prioritised in the manner that those of adults were during the pandemic. The proposed cuts should not be allowed, earlier reductions in children’s services should be reversed, and the welfare of babies, children and young people should be put at the centre of all policies for civil society.

We emphatically do not suggest that the problems described are intended outcomes, but without any changes, many leading stakeholders agree that state harm will come to be the phrase used to describe them.

Read the full response to the petition here: https://petition.parliament.uk/petitions/589522

The Government has given their response to the Petitions Committee’s landmark report on the impact of COVID-19 on maternity and parental leave.

The report was the result of an extensive inquiry following an e-petition calling for the Government to extend maternity leave by 3 months with pay in light of COVID-19 which received over 226,000 signatures, and to which Dr Cheryll Adams contributed some evidence via Zoom in May earlier this year (see iHV at Petition Select Committee).

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

Dr Cheryll Adams commented on today’s news on the Government Response:

“The Government Response to the report by the Petitions Committee’s recommendations on the impact of COVID-19 on parental leave is a disappointing response by government to such powerful lobbying by parents. So many new families have struggled during the past 6 months and more acknowledgement of that, in the form of positive responses to at least some of the recommendations, would have meant that they felt more valued in their essential role of bringing up the next generation.”

 

Dr Cheryll Adams CBE, Executive Director iHV, commented:

“Yesterday’s announcement of the public health grant allocations to local authorities provides a welcomed end to the lengthy period of uncertainty that has hampered service development. We hope that it will be enough to cancel immediate plans for further cuts to health visitors we have heard of from Yorkshire, London and the Midlands. Children’s potential health and wellbeing will remain at stake until a making good of the cuts to Public Health budgets over the past 5 years happens. We hope this will be announced in the next spending review.”

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.