Comment

Health visitors must stay on the front line for families in need

The pandemic has highlighted that a quality assurance process and workforce plan is vital for the future of health visiting

The pandemic has highlighted that a quality assurance process and workforce plan is vital for the future of health visiting

Picture: iStock

The COVID-19 pandemic has taught us many things and confirmed others, including that health visitors have their own front line. When you take the service away the impact on families is very significant.

Due to the pandemic, the service has been largely removed from providing face-to-face contacts and significantly reduced by the redeployment of health visitors in many areas.

The profession had already lost 30% of its numbers since a move to local authority commissioning in 2015, accompanied by a cut in the public health budget.

No clinics to go to, few home visits and a service unable to be as

The pandemic has highlighted that a quality assurance process and workforce plan is vital for the future of health visiting

Picture shows mother on phone with child. Health visiting has been severely affected by COVID-19
Picture: iStock

The COVID-19 pandemic has taught us many things and confirmed others, including that health visitors have their own front line. When you take the service away the impact on families is very significant.

Due to the pandemic, the service has been largely removed from providing face-to-face contacts and significantly reduced by the redeployment of health visitors in many areas.

The profession had already lost 30% of its numbers since a move to local authority commissioning in 2015, accompanied by a cut in the public health budget.

No clinics to go to, few home visits and a service unable to be as responsive as parents require

It was not long before parents spoke out about what the impact had been on them: no clinics to go to, few home visits and increasingly finding the service unable to be as responsive as they required.

They were particularly articulate about the challenges they face in a petition to the government calling for an extension of paid maternity leave, which obtained more than 200,000 signatures.

More recently, parents’ voices were heard in a survey that obtained responses from 5, 474 parents of babies, capturing their lockdown experiences.

Health visitors have spoken out too. The Institute of Health Visiting collected some of their feedback in which they described the immense stress from being unable to provide the services that they knew families needed.

One health visitor told me she was left with a caseload of 2,400 children after colleagues redeployed – the recommended maximum caseload is 250 children. Not surprisingly, this pressure led to sickness and further workforce pressures.

Sadly, one third of health visitors responding to a survey said they would like to leave the profession, according to University College London research.

After domestic violence charity Refuge reported a rise in domestic abuse rates, health visitors reported that they too were seeing more domestic abuse in the families they are responsible for.

Also widely reported has been the double impacts of loneliness and resultant mental illness. This has been played out in young families alone and cut off from their usual sources of support and the health visiting service.

‘Health visiting desperately needs a national quality assurance process to stop the postcode lottery of local decision-making’

Health visitors are telling us that as they reconnect with their families they find the incidence of mental illness has skyrocketed. Sadly, this is not the only thing affecting families. It is happening against a backdrop of increasing poverty and social exclusion for many.

It seems likely that soon we will find that infanticide rates have also increased. We know that babies under one year are most at risk.

Rebuilding of health visiting profession is needed to provide the services families seek

Health visiting as a universal service normally provides a safety net for all young families. When properly resourced, our service identifies issues early – whether a developmental delay or postnatal depression – and can arrange prompt referrals or provide interventions.

Picture shows strained mother at the kitchen sink with baby
Picture: iStock

The Institute of Health Visiting is relieved that our two chief nursing officers in England – Public Health England’s Viv Bennett and NHS England’s Ruth May – have agreed that health visitors must not be redeployed again, even if hospitalisations increase further.

However, that is just the beginning. Much rebuilding of the health visiting profession is required before all families receive the timely and skilled service they seek.

Due to COVID-19 restrictions and falling numbers, health visitors are currently struggling to contact all families face-to-face, although they now have access to personal protective equipment.

Clearly health visitors have their own front line and need to be on it

Health visiting is a resourceful profession and many innovative solutions have been found to improve access. Most employers have set up 9am-5pm health visiting helplines, and some health visitors have been given the equipment to run video consultations and clinics – even drop-in groups.

Others have set up socially distanced clinics with booking systems or have visited families in their garden on warm days.

What is clear is that health visitors have their own front line and need to be on it.

Many children and new families have become very vulnerable during the pandemic. Without prompt intervention so many problems are set up for the future.

Health visiting desperately needs a national quality assurance process

Many experts are predicting an epidemic of mental illness, and I regret to say there will also be a ‘COVID generation’ of children. These will be the children whose parents haven’t had timely information, those whose difficulties have been picked up late, and those whose needs have not been adequately met by unsupported parents.

It is so important that we respond quickly now.

Health visiting desperately needs a national quality assurance process to stop the postcode lottery of local decision-making set up when commissioning was moved to 151 cash-strapped local authorities, and a workforce plan to start to rebuild this vital profession. Children really can’t wait.

Cheryll Adams, executive director of the Institute of Health Visiting


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