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The state of health visiting in England


Health Visiting in England, Institute of Health Visiting, survey, health visitors, budget cuts, The government’s pledge to give every child the best start in life left in tatters after cuts.

Many health visitors in England are no longer able to protect vulnerable families after devastating cuts to public health budgets.

Public health budget cuts which have left health visiting services unable to offer even the minimum level of support in many areas.

That is the major finding of an annual survey of health visitors in England, published by the Institute of Health Visiting, (iHV), alongside calls to ring-fence new funding for the profession.

The findings from this survey presented a mixed picture of health visiting nationally, with welcomed improvements in a few areas and considerable workforce pressures in others, and indicate that the professionals best placed to help children get the best possible start in life lack the resources to do so.

The headline findings of the iHV State of Health Visiting survey are:

Only 21 per cent of health visitors rated the quality of care that they can now offer families as ‘good’ or ‘excellent’;

48 per cent of health visitors said they feel so stretched that they fear a tragedy where they work. This is up from 23 per cent in 2015, which even then suggested a profession under pressure;

29 per cent of health visitors are now responsible for between 500 and more than 1000 children;

While in 2015, 65 per cent of health visitors were able to offer continuity of carer to all, or most, families, by 2019 that number had fallen to just 35 per cent. Continuity of carer has been shown to be greatly valued by parents and health visitors, as it allows them to build a trusting relationship and gives parents confidence to ask for help;

58 per cent of health visitors reported that they are working longer hours and are feeling worried, tense and anxious;

36 per cent of health visitors said they would leave health visiting if they could;

Despite being mandatory, only 34 per cent of health visitors reported that they were able to offer an antenatal contact to families; and

81 per cent of health visitors reported that they are not conducting 12-month reviews of children and 90 per cent were not completing the 2 to 2.5-year review. These essential checks are most frequently delegated to more junior members of staff. This means that many families will not see a health visitor after their infant is 6-8 weeks old – especially with the closure of many child health clinics alongside the cuts to health visiting numbers.

Official figures indicate that around one in five health visitors were lost between 2015 and 2019 – the full-time equivalent of 18 per cent of the workforce. This is due to public health budget cuts and the failure to protect health visitors’ preventative role by many cash-strapped local authorities, after health visiting commissioning moved from the NHS to local authorities in 2015.

The consequences can be devastating – and 48 per cent of health visitors said they feel so stretched that they fear a tragedy where they work.

Almost a third of health visitors report they are now responsible for between 500 and over 1000 children – even though the iHV considers the optimal maximum to be 250 children in order for health visitors’ work to be fully effective, less in areas of high vulnerability.

The Institute is calling for:

1 – New ring-fenced cross-government funding for early intervention and the health visiting profession.

2 – Statutory protection for the health visitor role in leading the delivery of the Healthy Child Programme and for health visiting to be returned to statutory regulation.

3 – Workforce modelling and a new workforce strategy for health visiting.

4 – A new focus on improving the quality of services which health visitors can offer families, regardless of where they live.

Dr Cheryll Adams CBE, Executive Director of iHV, said: “It is absolutely unacceptable that many families are struggling through the significant demands of early childhood without the vital support that they need and are entitled to through the government’s flagship Healthy Child Programme.

“Indeed, the government’s pledge to give every child the best start in life has been left in tatters after year-on-year cuts to the public health grant, which have dismantled the health visiting services designed to support them in many areas.”

To read the full report, click here.

Please contact your MP and ask them to support the Institute’s call for change.

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