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Health visitors fear child tragedy

Health visitors are over stretched with increased casloads and stress

Published on 10th December 2018

More than 40 per cent of health visitors have warned that they are so over stretched that they fear a child tragedy.

With increased caseloads and stress levels, four in 10 health visitors told the 2018 Institute of Health Visiting (iHV) annual survey that they are so stretched they fear a tragedy at some point, when a child in need isn’t recognised until it’s too late.

President of the Royal College of Paediatrics and Child Health, Professor Russell Viner, said:  “Health visitors play a vital role in public health and prevention. They provide crucial health advice to parents, identify and put interventions in place for children with health, educational and potential safeguarding needs, and help to prevent accidents, injuries and more serious problems later in life.”

More than 1,200 health visitors responded to the survey and many cited increased caseloads, experiencing high levels of stress, and that they worry about not being able to deliver the services they should to all children with needs, especially the most vulnerable.

The survey showed that 44% of health visitors are working with caseloads of more than 400 children, up from 28% in 2015 when commissioning of their service transferred to local authorities. The Institute recommends a maximum of one health visitor to 250 children to deliver a safe service.

As a result of the higher casloads, 42% of health visitors reported that the quality of their service was inadequate or poor with increased stress levels (72%) in the practitioners and concerns about child safety.

Dr Cheryll Adams CBE, Executive Director iHV, said: “Cuts to public health budgets by the Treasury have led to a loss of around a quarter of the total health visiting workforce over the past three years (NHS Digital), but these losses aren’t consistent across the country with losses being greater in some areas and smaller in others.”

Furthermore, health visitors are reporting increased poverty with 69% of health visitors telling the survey they had seen an increase in the use of food banks over the past two years.  Health visitors also report working with many more families facing multiple adversities, including parental substance misuse, domestic abuse and mental illness.

The survey responses also indicate that health visitors’ capacity to deliver all of the five mandated universal health and development reviews from the Healthy Child Programme in England. Many reviews are delegated to non-registered practitioners without health training, and some are not carried out at all, with reports of around 65% families not having an appointment with a trained health visitor after their child’s 6-8 week contact, and even less, 79%, after the first year.

Dr Cheryll Adams added: “This is hugely worrying as many of the issues that health visitors are trained to assess during these contacts with families are hidden and are easily missed by less qualified practitioners.  This means that these issues may be much harder and more costly to address by the time that they become conspicuous."

The Institute is calling for:

- A reinvestment into public health services.

- A new joint integrated commissioning framework between local authorities and the NHS for universal children’s health services

- A refreshed and re-launched Healthy Child Programme and

- Enough health visitors to be able to address the unique needs of every child and family.

Dr Adams concluded: “Another round of public health budget cuts are due in 2019/20. Unless these are stopped now, we will see a further reduction in health visitors and more negative outcomes for children and families, and in turn, for society as a whole.”

Survey of health visitors in England



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