Unique challenges for mothers with multiple long-term conditions

1 in 5 pregnant women live with two or more long-term physical / mental health conditions. Examples include: diabetes, asthma, anxiety and depression.

Some women may need to attend many appointments with different specialist teams. Some may have to take multiple medications. This can be challenging when they have to juggle managing their health conditions with their role as a new mother. Their babies may be at risk of adverse outcomes such as prematurity and needing neonatal unit admission.

Health visitor’s role

Women with complex pregnancy may experience a lot of stress and anxiety during pregnancy and childbirth. They may take longer to recover, physical and mentally, after childbirth. Therefore, the support from health visitors beyond the 6-week postnatal period is invaluable, for the mother, infant, and family’s wellbeing and perinatal mental health.

The Mum-PreDiCT group wants to hear from health visitors

MuM-PreDiCT is a group of eight UK universities studying multiple long-term conditions in pregnancy. They want to find out what mother and baby outcomes are important to healthcare professionals (including health visitors).

They need help from health visitors to build a Core Outcome Set. This is a minimum standard list of outcomes that should be reported in all studies. This ensures that future studies measure what matters to health visitors, to help HVs make evidence-based decisions when caring for mothers with multiple conditions.

Thank you for your kind support!

Ing Lee, MuM-PreDiCT Clinical Research Fellow, University of Birmingham

This is your last chance to complete a short survey to influence the future of the public health workforce!

Survey closes midday tomorrow (12 Jan).

It is a crucial time for public health right now and the Royal Society for Public Health (RSPH) is calling for public health practitioners to take part in a very short survey to represent their views to help influence the future of the public health workforce.

The survey provides a fantastic opportunity for health visitors to highlight the challenges they are facing within their workforce and identify what solutions are needed. The survey focuses specifically on recruitment, retention and training.

Although the survey does not ask about individual public health professions and is quite broad in its approach, there is space to free text and expand on your thoughts so you can be specific about health visiting within these areas.

Your feedback will be used to help influence the RSPH’s submission to the Health and Care Committee’s inquiry into the future of the public health workforce.

It only takes about 10 minutes to complete the survey, so make yourself a cuppa and make sure your views are heard!

The survey closes at midday on Wednesday 12 January 2022.

Yesterday evening, ITV regional news broadcast a health visiting feature on the shortage of health visitors and how they are struggling to provide enough support for parents and children.

woman wearing glassess

Alison Morton, Executive Director iHV, being interviewed on ITV News

ITV was given exclusive access to the latest State of Health Visiting survey data, the national survey of health visitors collated and managed by the Institute of Health Visiting, which was published this morning (see our news story – Survey confirms babies, young children and families’ needs are increasing in the postcode lottery of support).

Alison Morton, Executive Director at the Institute of Health Visiting, said:

“Thank you to ITV and all the health visitors and families who supported this important news story. The piece highlights the impact of years of cuts to the health visiting service and the impact that this is having on families.

“Our survey findings this year paint a picture of a health visiting service under pressure with a headline message that ‘we need more health visitors’. 700 leading children’s organisations agree with us and supported our call for investment for more health visitors in the recent Spending Review.

“Whilst we welcomed the £500m investment in children 0-19 years announced in the recent budget, this does not go anywhere near far enough. So far, we have had zero pounds of investment for more health visitors. We call again on the Government to deliver on their pledge to ‘rebuild health visiting’ as a matter of urgency.”

We would like to say a heartfelt thank you to Charlotte, Mum to Ethan, for sharing her story about how her health visitor made a difference to her and her family. This would not have been possible without the tremendous support of Solent NHS Trust. Thank you to Claire Mcleod (HV and Clinical Modern Matron – Solent NHS Trust) for enabling Charlotte and Ethan to tell their story and for highlighting the vital role of the health visitor.

The news story and video on the link below is available on the national ITV News website and is a shortened version of the slightly longer news piece was shown in the regions yesterday evening.


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:

  1. 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.
  2. 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.
  3. 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.

Calling all health visitors and health visiting teams! We really need your help to increase our response rate to our annual state of health visiting survey.

The great news is we have had 884 responses to our survey so far (and a huge thanks to everyone who has already completed it!). The bad news is that, at the moment, thousands of health visitors will not get their views heard!

Our target is to reach 1000 responses as minimum!

I cannot stress how important our annual survey is. We will use the evidence to create a powerful picture of the current state of health visiting which we will use to influence national decisions.

Big decisions are being made right now about the funding for health visiting and the ways that the service is delivered In England – there is also a lot of variation across the UK which we need to demonstrate. Help us tell your story. What do you think? Is it working? What needs to change? Have your say to benefit the health of all families and your staff.

If we don’t speak out as health visitors, policymakers will presume that everything is working well. We know that you may be feeling tired and exhausted – or feel that your views won’t make any difference. Thank you for all that you’re doing supporting babies, children and their families, it really does make a difference and your views really do count.

A big response rate will provide evidence that will be difficult to ignore. Only last week we saw how the views of 3,000 organisations and individuals, who came together with ‘one voice’, stopped Hampshire’s decision to cut their health visiting service.

This is where I need your help – don’t presume that others will do this for you – please take 20 minutes out of your very busy day and complete the survey yourself, and encourage your colleagues to do the same. This will possibly be the best use of 20 minutes that you will have as health visitors today to change the future of our profession. Make a plan – do it now, or find some time in the next week to have your say.

The survey contains a variety of questions to capture the state of health visiting, including:

  • The ratio of children under 5 years per health visitor (if you get stuck on this question, please ask your manager to help you – the data is anonymised, so you can ‘tell it as it is’. The survey contains details on how to calculate this).
  • Workforce forecasting – numbers of health visitors planning to retire or leave health visiting in the next 5 years.
  • Changes in children and families’ vulnerability.
  • Staff wellbeing.
  • Staff CPD needs.

I hope that you will join with me and the hundreds of health visitors who have completed the survey so far – be part of the 1,000!!

Thanks so much for your support

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 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, or can’t find your email, and would like to complete this vital survey, please contact [email protected] to request the survey link.

Thank you so much for helping us to help you. Together we are stronger.

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.


Public Health England would like to understand parents’ views and experiences of healthy weight or healthy lifestyle services for children and families in their local area.

text about a survey

As part of a one-year programme, some local councils have been awarded new funding to increase their provision of healthy weight or healthy lifestyle services for children and families. For example, support to eat healthier and be more physically active which might include a referral to a local programme or group. Areas were selected following a competitive application process.

A short online survey has been developed to capture parents’ views of existing services in local areas to inform future investment.

Calling all HVs, please share the link with parents who might be happy to help with this. Please share attached information sheet and the link.

Learning from this survey will help improve services to ensure that all children have an opportunity to be healthy, no matter where they live.

Unfortunately there is a tight time line to generate and analyse results, as the insights are intended to feed into the upcoming bidding process for this year’s Spending Review – so responses are needed by Friday 30 July .


Calling all iHV members, tell us your views by 5 March 2021 for a chance to win a free ticket to an iHV conference during 2021!

We’d love to know more about how our members use their iHV membership – and also get your feedback on how we can improve our membership services for you. Our very short survey should take no more than 5 minutes of your precious time, but your views will be invaluable to us – and you get a chance to win a ticket to one of our highly popular conferences!

Check your January issue of iHV Times for the link and complete the survey by 5 March 2021 to be entered into a draw to win a free ticket to one of our fabulous 2021 conferences.

If you cannot find the link to our Jan 2021 membership survey, please contact [email protected]

Read below about our last lucky winner, Jen Menzies!

Jen Menzies
SCPHN HV and Senior lecturer Northumbria University

I always look forward to the arrival of my iHV Times, and avidly completed my membership survey last July.

I was delighted, after submitting my survey responses and entering the prize draw, to win a free conference place! I hope to use my prize to attend the evidence-based practice conference in September this year in Manchester.  I am optimistic this will be face-to-face!

The survey is a great way to ensure the iHV meets all the requirements of its members and, as both a practitioner and academic, the iHV resources ensure that I am up to date with contemporary issues and evidence-based practice in health visiting and the wider public health agenda. Particularly at present, during the COVID-19 pandemic, it is important we have online resources to help us navigate the new landscape in health visiting. The iHV is helping us do this virtually with its excellent free Insights webinars and e-resources to ensure we maximise the learning opportunities and remain aware of the latest evidence.

Jen Menzies, SCPHN HV and Senior Lecturer, Northumbria University


Today, The Duchess of Cambridge unveils the findings of the biggest ever UK study on the early years, in a milestone moment for her work on the importance of early childhood in shaping the rest of our lives and broader societal outcomes.

In January, Her Royal Highness asked the general public for their views – sparking a national conversation on the early years through the ‘5 Big Questions on the Under Fives’ survey which attracted over half a million responses, making it the biggest ever survey of its kind.

The research published today includes the findings of the ‘5 Big Questions’ survey as well as further qualitative and ethnographic research, a nationally representative survey conducted before the pandemic and a survey on the impact of COVID-19 on families.

Duchess of Cambridge at a briefing with Kelly Beaver (Managing Director of Public Affairs, Ipsos MORI) Credit: Kensington Palace

Taken together, these studies have generated 5 Big Insights:

  1. People overwhelmingly believe that a child’s future is not pre-determined at birth. However, most people don’t understand the specific importance of the early years. Answering the 5 Big Questions, 98% of people believe nurture is essential to lifelong outcomes, but just one in four recognise the specific importance of the first five years of a child’s life.
  2. The reality of life makes it hard for parents to prioritise their wellbeing. 90% of people see parental mental health and wellbeing as being critical to a child’s development, but in reality people do very little to prioritise themselves. Only 10% of parents mentioned taking the time to look after their own wellbeing when asked how they had prepared for the arrival of their baby. Worryingly, over a third of all parents (37%) expect the COVID-19 pandemic to have a negative impact on their long-term mental wellbeing.
  3. Feeling judged by others can make a bad situation worse. 70% of parents feel judged by others and among these parents, nearly half feel this negatively impacts their mental health.
  4. People have been separated from family and friends during the pandemic and at the same time parental loneliness has dramatically increased. Disturbingly, people are also less willing to seek help for how they’re feeling. Parental loneliness has dramatically increased during the pandemic from 38% before to 63% as parents have been cut off from friends and family. The increase in loneliness for parents is more apparent in the most deprived areas. These parents are more than twice as likely as those living in the least deprived areas to say they feel lonely often or always (13% compared with 5%). Compounding this, it seems there has been a rise in the proportion of parents who feel uncomfortable seeking help for how they are feeling from 18% before the pandemic to 34% during it.
  5. During the COVID-19 pandemic, support from local communities has substantially increased for many – but not for all.
    Across the UK, communities have united powerfully to meet the challenge of unprecedented times. 40% of parents feel that community support has grown. However, parents in the most deprived areas are less likely to have experienced this increased support (33%) than elsewhere.

These insights highlight the need to help people understand the importance of the early years and suggest that parents and carers need more support and advice to ensure good mental health and wellbeing as they raise young children.

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

“The Institute of Health Visiting welcomes the results of these very significant UK surveys of the early years being unveiled today by The Duchess of Cambridge. These findings, and the resulting ‘5 Big Insights’, are extremely important and helpful in shining a light on this important period and why more needs to be done to support the parents of young children.

“What happens in the earliest years of a young child’s life provides something of a blueprint for their later health and wellbeing, and their capacity to thrive in the educational setting and adult life. Much of this research was completed pre the COVID-19 pandemic and, from the recent feedback of health visitors, we would expect the results to be even more stark now.  We call on the Government to respond to yet more evidence of why investment in the early years is wise investment and with the capacity to actually reduce the fiscal spend in the longer term.

“We look forward to working with the Royal Foundation and our Early Years partners to disseminate these new findings and the ‘5 Big Insights’ to those who have the power to drive positive change for young families.”

Duchess of Cambridge at a briefing with Kelly Beaver (Managing Director of Public Affairs, Ipsos MORI) Credit: Kensington Palace



The findings provide an unrivalled insight into public attitudes on the topic and as well as informing The Duchess’ work in this area, it will also be a vital source of information for the early years sector, helping to improve understanding of public perceptions of the importance of the early years, and the first-hand experiences of parents, families and carers.

Next year, The Duchess will announce ambitious plans to help elevate the importance of early childhood.

Follow the conversation on hashtag #5BigInsights



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.

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.