Shortage of 5,000 health visitors mean they only reach 'tip of the iceberg' with vulnerable babies and children

More than two fifths of health visitors are worried they ‘can’t do enough to safeguard babies and children’, according to new research.

Research by the Institute for Health Visiting (iHV) reveals how health visitors have reported soaring rates of domestic abuse, mental health problems, child behaviour problems, poverty, and child safeguarding when they are accountable for over 750 children when the recommended ratio is one health visitor for 250 children from birth to age five, or less. According to the iHV, there is now a national shortage of 5,000 health visitors.

In total 1,291 health visitors were surveyed between October and November 2021 where 81 per cent reported a rise in perinatal mental health problems, 80 per cent an increase in domestic abuse and 71 per cent a rise in child safeguarding and over 85 per cent of health visitors reported an increase in speech, language and communication problems.

One health visitor said: “Our team is stretched so thin we dread new vulnerable families being added to our caseload, thinking where on earth are we going to get the time to support them?

“But we do, we make it happen, we turn up every day and keep going, our families would never know we feel this way if you asked them.”

The survey also showed an 80 per cent a rise in child behavioural problems, a 72 per cent increase in poverty affecting children and families and 42 per cent of health visitors worry they ‘can’t do enough to safeguard babies and children’.

Against this backdrop, health visitors did not stop, they have risen to the challenges and demonstrated that they are a modern, innovative, and responsive workforce which has continued to support families as far as possible through the most difficult circumstances.

A total of 15 per cent of health visitors reported that new birth checks are being carried out by practitioners who are not health visitors, while only 21 per cent said they are able to offer all families a two-year review.

The survey also showed health visitors have led the way in developing new ways of working to reach as many families as possible. Video-enabled contacts brought some welcome benefits but the majority agreed video contacts could not ‘safely or effectively replace face-to-face universal assessments’ or identify needs or enable disclosure of risk factors in vulnerable families.

Alison Morton, executive director at the Institute of Health Visiting, said: “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.”

The iHV is now calling on the government to fulfil their pledge to ‘rebuild health visiting’ with three specific policy calls:

• Introducing a £500 million ring-fenced uplift in the Public Health Grant over the next three years to reverse years of cuts, rebuild the workforce and enable sufficient resources to deliver the full breadth of the Healthy Child Programme of prevention and early intervention to all families. A ringfenced grant would provide protection from political cycles of disinvestment.

• The recruitment of 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.

• An end to the ‘postcode lottery’ of health visitor support and bring in real, meaningful accountability in public service delivery to ensure families receive personalised and effective support to improve child outcomes and reduce inequalities wherever they live.

The iHV report, 'State of health visiting in England' is available here, https://ihv.org.uk/wp-content/uploads/2021/11/State-of-Health-Visiting-Survey-2021-FINAL-VERSION-25.11.21.pdf