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 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 some children’s futures, as their numbers are cut!

More than 1 in 3 health visitors worry that they are so stretched that there may be a tragedy in their area at some point
More than 1 in 5 health visitors are working with caseloads of over 500 children

Results from the Institute of Health Visiting (iHV) annual survey 2017 show the worrying impact of a reduction in health visiting services on babies and families since responsibility for the service in England moved from the NHS to cash-strapped local authorities in October 2015.

This year’s iHV survey of over 1400 health visitors shows major concerns around safeguarding and protecting children at risk, with a third of health visitors in England feeling that they are so stretched that there may be a tragedy in their area at some point – this is up from 25% in 2015 and strongly suggests a very unsafe situation for both children and health visitors who must manage that risk and worry, and know they may be blamed if a child is injured.

The survey also disturbingly showed that more than 1 in 5 (21%) health visitors in 2017 are working with caseloads of over 500 children – which is in stark contrast to the 1 in 8 (12%) reported in the iHV survey in 2015 when the funding transferred from NHS to local government, and when a recommended ‘minimum floor’ was set of three whole time equivalent health visitors to cover 1000 children. The Institute recommends an average of one health visitor to 250 children to deliver comprehensive health improvement.

42% of those surveyed reported they can only offer continuity of care to vulnerable children and those subject to child protection processes (26% in 2015). This is worrying when it’s the ability of health visitors to build a trusting relationship with families over time that gives those families the confidence to disclose sensitive areas where they need help promptly.

Dr Cheryll Adams CBE, executive director of the Institute of Health Visiting, commented:

“Health visitors are advanced specialist practitioners, previously nurses or midwives, who are very skilled at working with families to support them through stressful times.

“We are being told that many families see a health visitor only until their child is 8 weeks old, with less skilled staff carrying out all their later developmental reviews. Health visitors’ time is being targeted to picking up work once done by social workers in some areas of the country, meaning that these health visitors are not able to deliver their primary preventative role – the only professionals previously able to offer this as a universal service.

“Without a universal preventative service many children and families in need will be missed until their problems become serious, which goes completely against the role and responsibilities of a trained health visitor and where they can have their greatest impact. Our worry is that the number of children needing care proceedings will increase, even more children will need mental health services, postnatal depression will go undiagnosed, there will be greater demand on GPs and hospital services and more children will enter school less well prepared in terms of their social, emotional and communication skills. Cutting the public health workforce is a false economy.”

Dr Adams continued:

“There is a significant research base that demonstrates the importance of investment in the early years to reduce later costs by up to eight or nine times including the cost of social care, the NHS and criminal justice services*. As a nation, we cannot afford to not invest in our children – they are our future. There is already a large group of children and families who are affected by the recent reductions to public health budgets, and without new investment this number seems set to increase.”

Download survey report - Health Visitors in England fear for some children's futures as their numbers are reduced

* See the work of Nobel Prize winning economist James Heckman: https://heckmanequation.org/resource/the-heckman-curve/ and Masters et al (2017), Return on investment of public health interventions: a systematic review http://jech.bmj.com/content/71/8/827