Comment

Health visiting: why heartbreaking lockdown stories make a powerful case for change

Resources need to be put where the pandemic’s effect on vital services has been most damaging

Institute of Health Visiting director insists the government needs to put resources where the damage to early years support has been greatest

Our public health capabilities have been tested to the limit during COVID-19.

In particular, the value of an effective health visiting service is being recognised, with families speaking out on social media about the effects on them and their children when they miss out on this vital support.

Frustrated parents have criticised health visitors for a lack of face-to-face contact, with suggestions that they have been ‘allowed to bow out’ during the pandemic. Some stories on social media are heartbreaking.

Although the criticisms can be difficult for health visitors to hear when they have been working so hard, we

Institute of Health Visiting director insists the government needs to put resources where the damage to early years support has been greatest

The value of an effective health visiting service is being recognised, with families speaking out on social media about the effects on them and their children when they miss out on this vital support
Picture: iStock

Our public health capabilities have been tested to the limit during COVID-19.

In particular, the value of an effective health visiting service is being recognised, with families speaking out on social media about the effects on them and their children when they miss out on this vital support.

Frustrated parents have criticised health visitors for a lack of face-to-face contact, with suggestions that they have been ‘allowed to bow out’ during the pandemic. Some stories on social media are heartbreaking.

Although the criticisms can be difficult for health visitors to hear when they have been working so hard, we are pleased that families are now speaking out, as they convey a powerful case for change that must be heard.

Lockdown has most affected people who were already disadvantaged

Let me be clear: health visitors have not bowed out. They should feel proud of all that they have achieved against the odds. The Institute of Health Visiting (iHV) has been overwhelmed by the innovative ways in which services have adapted to ensure that as many families as possible are supported.

So what are parents telling us? Some families have not seen their health visitor face-to-face in over a year. Having a baby in lockdown has been tough for families, and the normal struggles of parenthood have been amplified without the usual support in place. We have also heard many harrowing stories of families facing the brunt of the pandemic and being tipped into vulnerability for a multitude of reasons.

‘Councils in England have seen a reduction of £700 million in real terms in public health funding between 2014-15 and 2020-21. These cuts have led to a 31% reduction in the number of health visitors in England’

Lockdown has most affected those who were already disadvantaged. In an iHV survey published in December 2020 that obtained responses from 862 health visitors in England, 82% (707) reported an increase in domestic abuse, 81% (698) saw an increase in perinatal mental health problems, and 60% (517) said there was an increase in child neglect.

Health visiting being categorised as a ‘partial stop’ sent a message that it was not valued

Paediatricians and speech and language therapists are also reporting that without the vital safety net that the health visiting service provides, children with complex health conditions and developmental delay are being missed.

How did we let this happen? This state of affairs took hold long before COVID-19. It is not the failure of a single health visitor, provider or commissioner but is the predicted consequence of years of cuts to the service which the pandemic has only made worse. Councils in England have seen a reduction of £700 million in real terms in public health funding between 2014-15 and 2020-21.

These cuts have led to a 31% reduction in the number of health visitors in England. In March 2020 matters were made worse when health visiting was categorised as a ‘partial stop’ in the community prioritisation plan, sending a powerful message that health visiting was not valued.

‘Prioritisation comes with a human cost – how do you decide who receives additional support at a time when families have faced such an enormous test of their parenthood?’

Health visitors have told us that above everything else they have faced during the pandemic, this decision hurt the most. In some areas 63% of health visitors were redeployed, with those left behind facing unmanageable caseloads and services also scaled back.

Not enough health visitors to deliver the Health Child Programme

Like all parts of health and social care, the health visiting service is now in a restoration phase and staff are facing a huge backlog of work that requires prioritisation of the most vulnerable families. This prioritisation comes with a human cost – how do you decide who receives additional support at a time when families have faced such an enormous test of their parenthood?

When asked to prioritise those with known vulnerabilities, who will know who is vulnerable when families have not been seen? The most vocal will step forward but the evidence is clear that the families who need most support are the least likely to ask for it. Services are struggling to get back to business as usual as the simple truth is that there just are not enough health visitors to deliver the Healthy Child Programme as intended.

When will babies and young children get a look in?

It may take years before we know the full extent of the damage caused by the pandemic. What we do know is that babies, young children and their families need support now and they cannot wait. We need a plan to remedy this. So far our concerns have fallen on deaf ears.

‘We now need the government to put resources where the damage is greatest and needs are most desperate’

Prime minister Boris Johnson has pledged to build back better. But when will babies and young children get a look in? There is no build back better plan for them, nor any investment at the scale seen by most other parts of society.

We welcome the policy pledges from the government set out in the recently published Leadsom Early Years Review. We now need them to act like they mean it and put resources where the damage is greatest and needs are most desperate. Early intervention and health visiting are an important part of the solution and should be at the top of the list.


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