The Institute of Health Visiting (iHV) publishes its findings from the largest UK survey of frontline health visitors working with families with babies and young children across the UK – “State of Health Visiting, UK Survey Report: Millions supported as others miss out”.

It’s deeply shocking that 93% of health visitors reported an increase in the number of families affected by poverty in the last 12 months. Poverty was the cause of greatest concern to health visitors. They visit the homes that families are struggling to heat and witness the impossible choices that parents are forced to make about feeding their children or paying the bus fare to attend vital health appointments. These struggles are often hidden behind front doors and invisible to other services until the situation reaches crisis point. Alongside an increase in poverty affecting families over the last 12 months:

  • 89% of health visitors reported an increase in the use of food banks
  • 78% an increase in perinatal mental illness
  • 69% an increase in domestic abuse
  • 63% an increase in homelessness and asylum seekers
  • 50% an increase in families skipping meals as a result of the cost-of-living crisis.

Only 3% of health visitors surveyed reported that families had not been impacted by the cost-of-living crisis. Some reported that poverty was so widespread that it had become the norm.

In our survey, health visitors also raised concerns about the wider impacts of poverty and increased parental struggle on children’s health, development and safety. The Government’s own data show that more children in England are falling behind with their development and health inequalities are widening. Worryingly, the situation is getting worse and showing no signs of recovery.

The good news is that health visitors saw millions of families last year, reaching significantly more babies and young children than any other health service or early years agency. However, despite health visitors’ best efforts, they are not able to meet the scale of rising need. Too many babies and young children are not receiving packages of support to improve their health and development when they need it, due to ongoing cuts to the health visitor workforce:

  • There is a national shortage of around 5,000 health visitors in England and families face a postcode lottery of support.
  • 79% of health visitors said that the health visiting service lacked capacity to offer a package of support to all children with identified needs.
  • Only 45% of health visitors were “confident” or “very confident” that their service was able to meet the needs of vulnerable babies and children when a need is identified.
  • 80% of health visitors said that other services were also stretched and lacked capacity to pick up onward referrals for children with additional needs. Thresholds for children’s social care support had increased and other services had long waiting lists.

Alison Morton, CEO at the Institute of Health Visiting, says,

“Consistently, health visitors have told us that parenting has become much harder for many families over the last 12 months. Health visitors are in a privileged position, they see firsthand the struggles that families with babies and young children are facing, often hidden behind front doors and invisible to other services. Sadly, despite policy promises, more and more children are not getting the “best start in life”. And the situation is getting worse with more children falling behind with their development and widening health inequalities. As babies can’t speak for themselves, health visitors provide a vital “voice” for our youngest citizens and an important warning signal for policymakers who are prepared to listen. It doesn’t have to be this way, change is possible.”

We publish at the start of a new year, with political and economic uncertainty, but also with hope as all political parties consider their plans to improve the health of our nation ahead of a general election expected this year. Our survey findings highlight the incredible potential and desire within the health visiting profession to support a brighter future for our nation’s children. But we cannot ignore the fact that the health visiting workforce is under significant pressure with unacceptable levels of work-related stress, as health visitors manage enormous caseloads, and escalating levels of need and vulnerability. We urgently need more health visitors.

Alison concludes:

“Our survey findings present a clear imperative to act. If we get the early years right, we can avoid so much harm later in life. The cuts to health visiting in England over the last 8 years have been a false economy. When sufficiently resourced, health visitors can take pressure off busy A&E departments and GPs, providing support for families in the heart of the community. The costs to rebuild the health visiting service in England are small compared to the spiralling costs of NHS treatment, child maltreatment and cumulative costs across the life course. Investing in our children’s health is not only the right thing to do, it also makes sound economic sense.”

 

The NSPCC is calling on the Government to implement an updated and improved Healthy Child Programme alongside a robust NHS workforce plan.

Today, the NSPCC gained widespread print coverage on their health visiting story which highlighted that more than 84,000 babies have missed out on their new birth visit, in their first two weeks of life, last year.

Their story lays bare the figures from the Office for Health Improvement and Disparities (OHID) which showed a steep decline in the proportion of babies receiving a new birth visit by 14 days in England, from 88% in 2020/21 to 83% in 2021/22. The NSPCC also highlighted the wide variation of delivery between local authorities and the national workforce shortage of 5,000 health visitors in England.

The NSPCC is calling on the Government to implement an updated and improved Healthy Child Programme alongside a robust NHS workforce plan which will help give health visitors the resources and tools they need to adequately support families right from the start of a child’s life.

The story was covered in print in The Independent, Express, Daily Star, The i, Daily Telegraph, The Sun, Metro and Mirror and online in the Daily Mail as well as regional and online outlets.

There was also  broadcast coverage on Sky News as well as Good Morning Britain and across commercial radio stations.

Jack O’Neill, NSPCC senior policy and public affairs officer, said:

“It is vital that families receive that crucial first health visit as soon as possible after a child is born to ensure parents and the new baby are living in a safe and healthy environment”, and “called on Government to improve the Healthy Child Programme and boost health visitor numbers”.

Georgina Mayes iHV Policy and Quality Lead said:

“We welcome the  support and ongoing pressure from NSPCC to ensure that every baby gets the best start in life. Too many babies and children are currently missing out on vital health visitor mandated contacts. This matters as we now have unequivocal evidence on the importance of the earliest years of life – but we also know that becoming a parent can be a particularly challenging time for many families. Having access to the right support can make a big difference and can prevent small problems reaching crisis point. Sadly, too many families are missing out on the support that they need due to an almost 40% reduction in the number of health visitors, alongside rising levels of need.”

The situation is serious but it’s not too late to change direction and for the Government to ensure there is sufficient funding to deliver the Healthy Child Programme in full, including a national workforce strategy to address the shortfall of 5,000 health visitors in England. Whilst we welcome the Government’s workforce pilots announced in the autumn budget, and restatement that health visitors are one of six essential services, action to address the health visitor workforce shortages cannot wait another 2 years. Urgent action is needed now to put the brakes on and prevent further losses. The longer that this is left unaddressed, the harder it will be to deliver the Start for Life vision and rebuild the health visiting service in England.

The iHV would like to say a huge heartfelt thank you to the NSPCC for their unwavering support of health visiting and for championing babies, children and families. We would also like to say a special thank you to Jack O’Neill (NSPCC Senior Policy and Public Affairs Officer) and Pierre Hyman (NSPCC Policy & Public Affairs Manager) for leading this media story which has received excellent coverage.

New data on the health visiting workforce figures published yesterday show that health visiting (HV) numbers in England have reached an all-time low.

Raising concerns about the falling number of health visitors (HVs) in England has been challenging, as workforce data are not published in a single dataset. Since 2015, our members have been reporting a significant and ongoing reduction in HV workforce numbers and we have been calling for a workforce plan to address this – so far, this has fallen on deaf ears. Some policymakers have provided repeated reassurance that the situation is not as bad as the iHV has stated, as the NHS workforce data does not capture all the health visitors who work outside the NHS.

Yesterday’s publication of the most recent workforce numbers lays this bare. Health visitor numbers are falling in both NHS and non-NHS providers. There is now no doubt, if we want to retain an effective health visiting service in England, that we urgently need a HV workforce plan, and this cannot wait any longer. Despite health visitors’ best efforts, families are being left without the support that they need, and the consequences have been catastrophic for some families.

 Georgina Mayes, iHV Policy and Quality Lead, says:

“Despite health visitors working tirelessly, supporting hundreds of thousands of babies, children, and families during the pandemic, we do not have enough health visitors to meet rising levels of need. As a result, too many families are missing out on essential health visitor reviews and the vital help that they need. Consequently, families are feeling alone and let down; health visitors are reporting work-related stress and burnout, all of which risks further HVs leaving the profession. Urgent action is required by national Government now to address the health visiting workforce shortages.”

How are health visiting workforce data reported?

Health visiting workforce numbers are published in two national datasets, one captures the number of practitioners working for NHS organisations and a separate dataset presents a smaller number of health visitors who work in non-NHS organisations. Whilst we have watched a month-on-month decline in the numbers of health visitors working in the NHS, the last Independent Healthcare workforce data was last published in February 2021 which has made it impossible to get a clear picture of current overall workforce numbers.

The newly published data now fully exposes a crisis in the HV workforce.

HV workforce numbers are currently published via two datasets:

  1. The NHS workforce data (using data from May 2022) = 5979 FTE HVs employed by NHS organisations.
  2. The Independent healthcare workforce statistics (using data from March 2022) = 1051 FTE HVs employed by non-NHS organisations.

The current total combined published HV workforce data (August 2022) = 7030 FTE.

The graph below visually shows the rapid decline in HV numbers. The HV workforce has decreased by over a third (37%) since 2015.

graph of Health visiting workforce numbers employed by the NHS in England, Sept 2009 to Aug 2022

Contributing factors of the health visiting decline include:

  • The Public Health Grant falling from £4.2 bn in 2015–16 to £3.3 bn in 2021–22.[1]
  • A reduction in HV training places since 2015, which has coincided with budget cuts.

HV numbers are now well below the figures which triggered the Government’s Call to Action and investment in 4,200 more HVs in 2011 (7849FTE).

When adequately resourced, health visitors provide a vital infrastructure of support to all families – preventing problems and identifying needs early to reduce the burden of costly late intervention. Health visitors lie at the heart of the Government’s ‘Start for Life Vision’, as one of six essential services – we are therefore calling on the new administration to take the health visiting workforce situation seriously and provide the much-needed investment and the workforce plan that will be required to deliver this vision.

This is needed now more than ever to address the health visiting workforce crisis and reverse the national decline in the profession.


[1] The Health Foundation 2021 ‘Public health grant allocations represent 24% (£1bn) real terms cut compared to 2015/16’ (16 March)
https://www.health.org.uk/news-and-comment/news/public-health-grant-allocations-represent-a-24-percent-1bn-cut

 

MPs to question Health and Social Care Secretary, Sajid Javid, on plans to rebuild the workforce

The Health and Social Care Committee has announced that, on Tuesday 25 January at 4pm, MPs will scrutinise Sajid Javid on his plans to deal with the multiple crises facing the sector in a one-off session. The session is expected to cover the Government’s workforce strategy, including provisions set out in the Health and Care Bill. Staff pay, employee burnout and integrating social care and NHS workforce planning are on the agenda.

Do you have a question you would like to ask the Secretary of State for Health and Social Care, Sajid Javid?

If so, you can ask you question on Twitter using the hashtag #QuestionJavid

Please submit via Twitter (with the hashtag) by 5pm today (Friday 21 January)

Our State of Health Visiting in England Report showed that Health visitors in England are reporting soaring rates of domestic abuse, mental health problems and child safeguarding, with evidence of significant reduced workforce capacity to meet these demands.

Do our survey findings reflect your own experiences?

A recent publication of health visiting workforce numbers employed by the NHS in England between September 2012 to September 2021 show that health visiting numbers in England are below the last workforce crisis in 2011 which led to a health visiting Call to Action!

This is an opportunity to have your voice heard.

Start typing your questions into Twitter now! And tag with #QuestionJavid.

You can watch the session live on parliamentlive.tv  on Tuesday 25 January at 4pm.

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.

The iHV shares the concerns of the Royal College of Paediatrics and Child Health (RCPCH) that children’s health services are being put at risk by a serious shortage of paediatricians.

Gaps in paediatric rotas, uncertainty over the status of non-UK nationals working in the NHS, poorly co-ordinated planning, and a demoralised workforce, are putting increasing pressure on child health services and placing quality of care in jeopardy, according to a new report from the Royal College of Paediatrics and Child Health (RCPCH).

It shows that demand for children’s healthcare is increasing, with the number of hospital admissions for children in England rising by 25% between 2013/14 and 2015/16, from 1.2million to 1.5million and attendances by children at Accident and Emergency Departments growing by 7%, from 4.5 million to 4.8 million over the same period.

Dr Cheryll Adams CBE, executive director, iHV, said:

“The iHV shares the concerns of the Royal College of Paediatrics and Child Health (RCPCH) that children’s health services are being put at risk by a serious shortage of paediatricians.  This situation, coupled with the reducing numbers of health visitors, will have a drastic impact on the health and wellbeing of babies, children and families.  A health visitor’s role is to help parents to manage minor illnesses and reduce accidents within the home and so reduce the numbers of babies and children needing to go to hospital.  But the reducing health visitor numbers will put a greater demand on reducing paediatric services, which will have economic consequences for the future, particularly on the already cash-strapped NHS.”

The RCPCH Report “The State of Child Health: The Paediatric Workforce” is based on data from the RCPCH Workforce Census 2015, with additional data from the Office of National Statistics, and RCPCH trainee recruitment processes.