The Institute of Health Visiting’s State of Health Visiting Survey 2016 shows the drastic impact the cuts to the local authority public health budgets are already having on the universal public health services delivered by health visitors. In response, the Institute is calling upon the government to reinvest in public health to protect and support mothers and babies by stopping cuts to the health visiting service by cash-strapped local authorities.

According to the State of Health Visiting survey 2016, 85% of health visitors (HVs) of the 1224 surveyed say their workload has increased over the past two years – with 40% of the increase in workload due to a reduction in the number of health visitors, this is despite the huge investment which went into the service between 2012-15.  16% of HVs reported they now have caseloads of between 500 and 1000 children – the optimum average caseload for safe and effective practice is 250.  Most worryingly, this is at a time when 80% of the respondents also report seeing an increase in domestic violence and abuse and perinatal depression in the families they visit.

The cuts have impacted on the delivery of the universal service, with only 70% of all families receiving the mandated health visitor reviews at 6-8 weeks, one year and 2-2.5 year, and only 30% of all families receiving the antenatal visit.  Through these stretched resources, only 5% of HVs are able to offer consistent continuity of care to all families and 72% worry about providing inadequate safeguarding and child protection support.

Official figures show that at least 988 full time posts (NHS Digital, 2016) have been lost between Sept 2015 and August 2016, with 56% of local authorities planning further cuts next year (Evidence to Health Select Committee, 2016).

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

“Our annual survey of the state of health visiting shows a radical downgrading of this public health asset, which serves the most formative period of children’s lives.  Health visitors should provide a universal service to every family in the country with a child under the age of five. This survey hence exposes the risks to all children and families from a decommissioning of health visitor posts, which it seems is just about to accelerate. The impact will not only be felt by children and families, there will be a knock-on effect on the NHS and other local authority services such as safeguarding services.  We can expect increased use of secondary health and local authority children’s services in the short, medium and longer term as many health and social concerns won’t be identified early enough. The cuts will also increase health inequalities as needy families will be missed until their problems are obvious.”

iHV is a signatory to a letter, lead by the Royal College for Paediatric and Child Health (RCPCH), which was sent to the Health Service Journal (HSJ) in response to an article written last week about how public health cuts are damaging to child health.

The HSJ investigation revealed that services aimed at children and young people are bearing the brunt of cuts to public health spending by local authorities.

Overall, their analysis identified planned spending reductions worth £50.5m in 2016-17, across 77 local authorities which provided information. Of the £50.5m cuts in 2016-17, the biggest single area was a £7m reduction to services directly aimed at improving the health of children and young people, such as health visiting, school nursing and childhood obesity programmes. These represented 14% of the total.

The letter signed by 12 leading specialists, warned that any spending cuts imposed by local authorities could have a “significant impact on the future health of children”. Scaling back spending on health visitors, child obesity programmes and school nurses will have a detrimental effect on the future health of children and young people in the UK it said.

A copy of an article in relation to this can be found on the HSJ and you can see a copy of the letter in full on the RCPCH’s website.

The letter is also shared below:

Dear Sir,

At a time where child wellbeing in the UK ranks a poor 16th out of 29 income rich countries, putting us below Slovenia and the Czech Republic, children are becoming overweight or obese earlier and breastfeeding rates are deemed the worst in the world, it is highly concerning to learn that of the £50.5m spending reductions planned for 2016-17 by local authorities, the biggest single area affected was services directly aimed at improving the health of children and young people (‘Children’s services hardest hit by public health cuts,’ 4 July 2016). Cuts are also affecting services for pregnant women such as smoking cessation and this could have a significant impact on the future health of children.

If we are to improve outcomes for children and young people in the UK, then it is vital that services provided by local authorities such as health visiting, school nurses and weight management programmes are protected. Without them, obesity rates will rise and the associated health costs will spiral, breastfeeding rates will fail to get better and thousands of babies each year will miss out on the many benefits it provides. In addition, obesity prevention, school nurses and health visitors are all important in the prevention and early detection of mental health problems, so these services are vital for maintaining both the physical and mental health of our children. We call on Government to invest in child health now because by doing so, it will protect the future health of the nation.

Professor Russell Viner, Officer for Health Promotion, Royal College of Paediatrics and Child Health (RCPCH)
Shirley Cramer, CEO, The Royal Society for Public Health (RSPH)
Professor John Middleton, President of the Faculty of Public Health
Sarah Carpenter, head of Health, Community Practitioners’ & Health Visitors’ Association
Sarah Carpenter, head of Health, Unite
Dr Ingrid Wolfe, Chair, British Association for Child & Adolescent Public Health
Janet Davies, Chief Executive & General Secretary at the Royal College of Nursing
Dr David Richmond, President, Royal College of Obstetricians and Gynaecologists (RCOG)
Dr Cheryll Adams, CBE, Executive Director, Institute of Health Visiting
Cathy Warwick, CEO, Royal College of Midwives
Jane Barlow, President, Association of Infant Mental Health
Stephen Dalton, Chief Executive, NHS Confederation
Bernadka Dubicka, Vice-chair, faculty of child and adolescent psychiatry, Royal College of Psychiatrist, Honorary reader, University of Manchester; Consultant psychiatrist, Lancashire Care Foundation Trust
Prof Karen Middleton, chief executive of the Chartered Society of Physiotherapy