Survey confirms soaring demand for health visitor support and large gaps in provision across the UK

The Institute of Health Visiting (iHV) publishes its findings from the largest survey of health visitors working with families with babies and young children across the UK – “State of Health Visiting, UK Survey Report – From disparity to opportunity: The case for rebuilding health visiting”.

Our survey, now in its 11^th year, gathers valuable intelligence from health visiting practitioners across the UK who see the realities of family life and the challenges currently being faced by so many families with babies and young children. The findings highlight a stark increase in complex needs among families, coupled with a severe shortage of health visitors and significant disparities in service provision.

Key Findings:

Rising Needs: Families are facing increasingly complex health and developmental challenges, yet the support they need is becoming harder to access.
Service Gaps: There are massive differences in the availability of health visitor services across the UK, creating a postcode lottery that leaves many families without essential early support that can make such a big difference.
Workforce Strain: Health visitors are under immense pressure, with unmanageable workloads, enormous caseloads and a longstanding workforce crisis that is threatening the sustainability of services.

The report underscores the urgent need for government intervention to address these critical issues. Without immediate action to increase the number of health visitors, the health and wellbeing of countless families and children are at risk.

The Government has committed to change the trajectory to raise the ‘healthiest generation of children ever’, ‘strengthen health visiting’, and shift the dial from ‘sickness to prevention’. There is a clear imperative to act now for the benefit of all babies, children and families, but there is much work to be done to achieve this.

84% of practitioners reported that the demand for health visiting support had increased over the last 12 months; however, the workforce has not kept pace with the increasing needs and practitioners reported falling health visitor numbers across all UK nations.
Families want personalised care. But only 45% of health visitors in England are able to provide continuity of carer to families “all or most of the time” compared to 90% in Scotland, 86% in Northern Ireland and 85% in Wales.
In England, demand for health visiting support is currently far in excess of what services are commissioned and able to provide; 73% of health visitors said workforce shortages impacted on their ability to support families when a need was identified.

The increased demand by families for health visiting support over the last 12 months is for multiple reasons, with perinatal mental health problems being the top reason across the UK. Practitioners have also seen soaring demand for support for:

Child behaviour problems, including growing concerns about neurodevelopmental issues like autism and ADHD that need to be taken seriously (and were ranked as the 2nd highest reason why families needed extra help from health visitors in Scotland, Wales and Northern Ireland).
In contrast, practitioners in England said that their practice was dominated by social concerns; with more families needing help with the impacts of poverty and with babies/children who have safeguarding concerns below the threshold for Children’s Social Care.

Practitioners reported unacceptably high rates of work-related stress due to the nature of their work, as well as the trauma of being the frontline practitioner who must tell families that they cannot provide the care that they need due to a “broken NHS”.

Alison Morton, iHV CEO said:

“The report highlights the urgent need for investment in health visiting services. Health visitors want to deliver high-quality, personalised, and equitable healthcare to all families – but this cannot remain a “hope” that is limited to words in the pages of policy. We need to get the basics right and this requires action to rebuild the health visiting workforce that has been cut beyond the bone in too many areas.

“The needs of babies, children and families must lie at the heart of all service transformation – currently too many have been left waiting too long without the support that they need, which we know can make such a big difference to their outcomes. Failing to act is a false economy. Childhood matters because it is short – there is no time to lose, the devastating impacts of not intervening are well known and have both a human and economic cost.

“Whilst the current picture is bleak, we remain optimistic for a better future. The findings demonstrate that, despite the current challenges and unacceptable disparities in healthcare, change is possible. The health visiting workforce is ready, willing and able to play its part to halt the decline and rebuild, to ensure that the UK has a world-class health visiting service so every baby can have the best start in life.”

The survey findings position health visiting as a safety-critical workforce, essential to safeguarding and improving outcomes for babies, children and families.

The survey findings are presented in four themed sections:

I. Babies, young children and their families’ needs – including child health, development and safety
II. Health visiting services, responding to need across the UK: widening disparities
III. Health visiting workforce matters
IV. Strengthening health visiting – train, retain, reform.

We’re calling for the following key changes:

Funding – A realistic and accurate level of funding that reflects the true scale of need for health visiting services. Adequate resourcing will ensure:
i. Accessible Services: Expanded reach of health visiting services to all families, particularly those in underserved communities.
ii. Increased Workforce: Recruitment and retention of skilled health visitors to manage appropriate caseloads.
iii. Enhanced Training: Continuous professional development to equip health visitors with up-to-date knowledge and skills to drive high-quality care.
iv. Strengthened health visiting services: Maximise the role of health visitors to reduce pressures in the NHS through a shift to the community and an increased focus on prevention, improving immunisation uptake, and reducing disparities in antenatal and postnatal healthcare.Long-term investment will help services to plan and build world-class services, ending the uncertainty of short funding cycles.

Workforce – Train, retain and reform the health visiting workforce across the UK
i. In England specifically: To deliver the national long-term workforce plan in full, ensure accurate workforce forecasting to meet the scale of need; and, in line with other UK nations, develop a robust, evidence-based safer staffing tool to ensure safe and effective care.
Quality – National government must do more to end the current postcode lottery of health visiting support:
i. The needs of babies, children and families must be at the centre of healthcare delivery, with system blockers removed to enable best practice and integrated healthcare.
ii. All areas must provide health visiting services that reflect best practice, and are proportionate to the scale of need, with mechanisms to hold failing areas to account. (In England, the Commissioning Guidance needs strengthening with explicit governance to reduce disparities and drive high-quality healthcare).
iii. “Health” must remain a central component of health visiting to enable health visitors to play their fullest part in improving health and reducing inequalities for babies, children and families.
iv. Health visiting research, workforce development and the sharing of evidence-driven models of best practice are supported.

Read the full State of Health Visiting, UK Survey Report - From disparity to opportunity: The case for rebuilding health visiting here

To cite this report, please use the link to the pdf here: https://bit.ly/4hmR3Me

Your voice is crucial! Make it count!

It’s that time of year again – the opportunity for everyone who works in health visiting to contribute to the largest and most important survey of health visiting across the UK. We cannot stress how important the iHV annual health visiting survey is. The findings provide a powerful collective voice for health visiting and the families that we support.

Make your voice count! You see what is happening behind families’ front doors that is often invisible to other services. Health visiting is in a unique position as it provides the only systematic and proactive way of reaching all families with babies and children across the UK.

Our survey collects vital information on changing trends for child health, development and safety. This provides an important early warning of changing needs, long before they are captured in national child outcome data. Your valuable frontline practitioner intelligence is second to none!

What information is collected: Tell us how the needs of babies, young children and families have changed over the last 12 months? How are health visiting services responding? What’s going well? And what are the challenges that need addressing? Help us to speak up for the profession and make sure that we accurately reflect the realities that you see in practice.

Who can complete the survey? We want to hear from health visitors and anyone working in other roles in health visiting teams. All responses are anonymised to maintain confidentiality, so you can tell it as it is. This is probably one of the most important uses of 20 minutes of your valuable time.

What difference will the findings make? Each year, the iHV uses your valuable frontline practitioner intelligence to influence national policy, across numerous government departments, as well as party manifestos. We also use it in a multitude of evidence submissions to government enquiries, national conference presentations and briefings for government meetings. Last year, the findings attracted significant media interest and received excellent television, radio and print media coverage which helped to raise the profile of health visitors.

Health visitors are making a difference to families – supporting hundreds of thousands of families every year across the UK. With your help, we aim to make the work of health visiting more visible. Over the last year, we achieved a welcomed commitment to invest in health visiting from both the current government and leading opposition party.

But our journey is far from over. As health visitors, we need to keep speaking up and making the case for prevention and early intervention to address the challenges faced by families across the UK. The future health and wellbeing of countless babies, children, and families really do depend on us being a national voice – especially for those that are often invisible to other services and struggle to be heard. Investing in health visiting also makes sound economic sense!

Fill in our survey now to make sure your experience is counted!

If you are an iHV member, you should have received an email in the last day or so with a link to our survey – please email us at [email protected] if you did not receive this.

If you are not an iHV member (and you are a health visitor, or work in a health visiting team) you can still complete our survey – please email us at [email protected].

Help us to get the biggest response ever – this will make the findings harder to ignore!

Thank you for all your support.

Thank you for making our collective voice louder!

What a fantastic team effort!! Together we did it – we smashed our annual survey target with a phenomenal 1,323 responses, making our collective voice louder!

We would like to say a huge heartfelt thank you to everyone who generously gave their time and completed our annual survey. Having such a large response rate adds considerable weight to the findings and makes the results much more powerful and very difficult to ignore.

We will use our survey findings to influence national policy making and decisions. We have already received considerable media interest in the 2022 survey findings which is excellent news for us. Our next steps are analysing and synthesising the data so we can accurately tell your story and highlight the challenges that babies, young children, and families are facing across the UK.

Keep an eye out for the annual health visiting survey report which will be published in mid-December.

Thank you so much for making our collective voice louder and turning our whisper into a roar!!

Together we are so much stronger.

Survey confirms babies, young children and families’ needs are increasing in the postcode lottery of support

The Institute of Health Visiting (iHV) publishes the findings from its annual survey ‘The state of health visiting 2021: we need more health visitors’ – capturing the experiences of frontline health visiting practitioners working with families across the United Kingdom in the wake of the COVID-19 pandemic. The findings confirm that the needs of babies, young children and families are increasing, there are not enough health visitors to meet these rising levels of need, and families are experiencing an ongoing postcode lottery of support.

The survey findings present the health visiting service’s unique view into the lives of families living through the pandemic, often hidden behind front doors and invisible to other services, with reports of soaring rates of domestic abuse, mental health problems, child behaviour problems, and child safeguarding. They tell the story of escalating numbers of families facing poverty and adversity, and due to successive years of cuts to the health visiting service in England, many families have been without access to the early help that can make a big difference.

There is a national shortage of around 5,000 health visitors in England and with services so stretched in some areas, 42% of health visitors are worried that they can’t do enough to safeguard vulnerable babies and young children. The pandemic is not over – but what is clear is that its impact on babies, young children and families is ongoing and has been significant.

Alison Morton, Executive Director at the Institute of Health Visiting, says,

“Our survey findings this year paint a picture of a health visiting service under pressure due to the impacts of the pandemic which affect the most disadvantaged families the most and increase the demand for health visiting support.

“In many areas, despite health visitors’ best efforts, the service is now so stretched that they can only reach the ‘tip of the iceberg’ of need and vulnerable babies, young children and their families are being let down.”

Over the last twelve months, health visitors have seen widening health inequalities with an increase in vulnerability and safeguarding risks with: 81% of health visitors reporting an increase in perinatal mental health problems; 80% an increase in domestic abuse; and 71% an increase in child safeguarding. In addition, 86% of health visitors reported an increase in speech, language, and communication problems; 80% an increase in child behavioural problems; and 72% an increase in poverty affecting children and families.

Alison continues:

“Becoming a parent can be challenging for a multitude of reasons. The good news is that getting help early can make a big difference. The pandemic has left many families without this vital safety net of early support provided by a health visiting service that reaches out to them. We know that many families find it difficult to take that first step in asking for help, and babies can’t ask for help if they are distressed and their parents are struggling. Therefore, it is vitally important that we have a universal health visiting service that reaches out to all families.”

Health visitors are Specialist Community Public Health Nurses who provide a vital infrastructure of support for all families, and a crucial safety-net identifying vulnerable babies and young children who are often otherwise invisible to services.

In England, the pandemic hit the profession at a time when it had the least capacity to meet families’ rising levels of need. Health visitors’ abilities to respond were compromised due to variations in local health visitor delivery models and the extent of pre-existing workforce capacity issues. Families have faced the brunt of this with a ‘postcode lottery’ of support and many health visitors are struggling to practise safely with large and unmanageable caseloads:

Only 9% of health visitors in England reported that they have the recommended ratio of 250 children aged 0-5, or less, per full time equivalent health visitor (FTE HV); compared to around two-thirds of health visitors in Scotland and Wales

Worryingly, more than 1 in 4 health visitors in England report that they are accountable for over 750 children (in Scotland and Wales, no health visitors have caseloads of this size).

As a result, many families are not seeing a health visitor at the routine health and development reviews mandated by the Government; for example, the report findings highlight that:

Only 21% of health visitors report that they are able to offer all families the antenatal contact
Only 21% of health visitors are able to offer all families a two-year review

Alison concludes:

“We urgently need more health visitors. Following years of cuts, the health visiting profession faces its biggest workforce challenge in living memory. Alongside 700 leading children’s organisations who supported our Spending Review call for more health visitors, we call on the Government to make good their pledge to ‘rebuild health visiting’.

“The Government say that they will maintain the Public Health Grant, but this is being maintained at a level that is too low to fund the number of health visitors needed to support all families, respond to rising levels of need and identify vulnerable babies and young children.

“Investment in health visiting is needed to provide the prevention and early intervention support to stop the well-reported growing tsunami of children in crisis. This cannot wait any longer – our nation’s children deserve better.”

The Institute of Health Visiting urges the Government to consider the implications of these findings on their plans to deliver the Start for Life vision to support families in giving their baby the best start in life.

We call on the Government to make good their pledge to ‘rebuild health visiting’ with 3 specific policy calls:

Funding – We are calling for a £500 million ring-fenced uplift in the Public Health Grant over the next three years to reverse years of cuts, deliver the Government’s pledge to ‘rebuild health visiting’, and ensure sufficient resource to deliver the full breadth of the Healthy Child Programme of prevention and early intervention to all families. A ring-fenced grant would provide protection from political cycles of disinvestment.
Workforce – We need 5,000 more health visitors in England with the specialist community public health nursing skills to support families through prevention and early intervention, and address a multitude of physical and mental health needs, child development priorities, social issues and safeguarding concerns which can impact on outcomes for babies and young children. Workforce forecasting, training, recruitment, and retention plans are needed to address current capacity issues and predicted losses, build leadership capability, and support succession planning.
Quality – An end to the ‘postcode lottery’ of health visitor support. Real, meaningful accountability in public service delivery is needed to ensure that families receive personalised and effective support to improve child outcomes and reduce inequalities wherever they live. The iHV is concerned that the Budget outcome metrics for Best Start all relate to ‘education’ and that ‘health’ has been overlooked. History has shown us that ‘you get what you measure’ and, without effective levers to assure the quality of health visiting services, this will lead to further erosion of preventative public health and weaken the health visiting contribution to multiple health pathways.

Download ‘The state of health visiting 2021: we need more health visitors’ report

We need your help to #TurnOffTheTaps – complete the iHV annual HV survey

Calling all health visitors and everyone working in health visiting – we need your help more than ever to bring investment back into health visiting to make sure that every baby, young child and family, wherever they live, has access to a well-resourced health visiting service.

This is urgently needed as we currently have a ‘Wild West’ in health visiting in the UK with a postcode lottery of support, which you face the brunt of on a daily basis – things need to change and we need your help to make this happen by filling in our important annual survey.

When I trained as a health visitor, like many of you, I was taught that the best way to drive change and reduce inequalities is to do it ‘with the evidence’. If one person says that things need to change, you might expect a ripple of interest – however, if we have a collective voice speaking together about the realities of health visiting (the bad and the good – as we know there is also a lot of great work taking place) then this makes a powerful case for change.

This is where we need your help – I know you are busy, tired and probably wonder if there is any point as this has gone on for such a long time. You may be thinking that your views don’t count, but they really do – every single one of you reading this post has a different experience and we need to pull this together into a national picture of health visiting.

Will you join with us to do this and help #TurnOffTheTaps and strengthen our case for investment into health visiting?

It’s a fairly simple ‘ask’ – please can you find 20 minutes this week, or over the weekend, to fill in our survey – make a cuppa and tell us how things are for you – the good, the bad… and the ugly.

(We know the survey is quite long, but please can I encourage you to stick with it to the end as we think every question collects a different part of the story we think we need to tell).

Then we will do everything in our power to get your voice heard.

There is power in a ‘united voice’ – please join with us to get this heard!!!

Alison Morton, Executive Director, iHV

How to take part in the annual State of Health Visiting Survey

For those people on our mailing lists (including members and expired members), you will have received an email from us yesterday evening with the survey link. So please do check your emails.

For those health visitors or members of health visiting teams who are not on our mailing lists and would like to complete this vital survey, please contact [email protected] to request the survey link.

New survey shows health visitors need more time to provide PMH support to new mums

The results from the Institute of Health Visiting’s State of Health Visiting Survey 2015 to find out today’s demands on health visitors will be shared with key figures from the world of health visiting and guests at the Institute’s third iHV annual celebration event being held in London on 7 December 2015.

68% of health visitors have seen an increase in postnatal depression over the last two years. 1 in 4 health visitors cannot provide every family with a postnatal mental health (PMH) assessment at 6-8 weeks, and 3 in 4 cannot at 3-4 months as recommended by the government according to the new survey findings announced by the Institute of Health Visiting (iHV) and published in their annual report on Monday 7 December. Although these figures have improved from previous years due to the investment in health visiting by the government, they make clear the service remains under resourced locally to implement this important area of public health.

Read full press release

Dr Cheryll Adams, Executive Director of the iHV