More than 1 in 3 health visitors fear a ‘tragedy in their area’

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Health visitor numbers are putting the care of children at risk

More than a third of health visitors are worried that a tragedy is likely to occur in their area at some point because of under-staffing and excessive workloads, according to the annual Institute for Health Visiting (iHV) survey 2017.

This year’s survey, of over 1400 health visitors, revealed that 1 in 3 health visitors in England fear for the safety of their patients – up from 25% in 2015. In addition, more than 1 in 5 are dealing with caseloads of over 500 children. This is a considerable increase from the 12% in 2015 and well above the iHV recommended ‘minimum floor’ of 3 full-time health visitors to 1000 children.

Dr Cheryll Adams CBE, executive director of the Institute of Health Visiting, said: ‘Health visitors are advanced specialist practitioners, previously nurses or midwives, who are very skilled at working with families to support them through stressful times.

‘We are being told that many families see a health visitor only until their child is 8 weeks old, with less skilled staff carrying out all their later developmental reviews. Health visitors’ time is being targeted to picking up work once done by social workers in some areas of the country, meaning that these health visitors are not able to deliver their primary preventative role – the only professionals previously able to offer this as a universal service.’

Health visitors are experienced and qualified nurses who then go on to train as health visitors and deliver care to young children in a variety of settings. Since 2015, when funding was transferred from the NHS to cash-strapped local governments, there has been a noticeable decline in the number of health visitors and an increase in the services they are expected to provide.

According to NHS digital workforce figures, there has been a fall of more than 2000 whole time equivalent (WTE) health visitors between October 2015 – August 2017 for those working within the NHS. Of those surveyed, 51% reported cuts to health visitors posts, 16% to their ‘skill-mix team’ and 12% were waiting on news of the scale of future cuts. Only 22% reported no cuts at their workplace.

This year’s survey also showed that 42% of respondents said they can only offer a consistent level of care to vulnerable children and those within child protection schemes – this was up from 26% in 2015. Part of a health visitor’s role is to provide care and support to children in their area by establishing a trusting relationship with parents, working together to promote preventative practice, identify issues in family settings and support children and parents through the early years of child care.

Dr Adams said: ‘Without a universal preventative service many children and families in need will be missed until their problems become serious, which goes completely against the role and responsibilities of a trained health visitor and where they can have their greatest impact.

'Our worry is that the number of children needing care proceedings will increase, even more children will need mental health services, postnatal depression will go undiagnosed, there will be greater demand on GPs and hospital services and more children will enter school less well prepared in terms of their social, emotional and communication skills. Cutting the public health workforce is a false economy.

‘There is a significant research base that demonstrates the importance of investment in the early years to reduce later costs by up to eight or nine times including the cost of social care, the NHS and criminal justice services.

‘As a nation, we cannot afford to not invest in our children - they are our future. There is already a large group of children and families who are affected by the recent reductions to public health budgets, and without new investment this number seems set to increase.’

Speaking back in October, Dr Adams had warned: ‘Children’s needs seem to have become invisible among the many competing demands being made on the government and the NHS. We want ministers and commissioners to understand that we cannot afford not to invest in our children’s health. They are our future!’

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