Overstretched health visitors 'unable to offer good support'

The Institute of Health Visiting's (IHV) State of Health Visiting in England report states that just 21 per cent of the workforce rated the quality of care they can now offer families as ‘good’ or ‘excellent.

The report is based on the accounts of 1,040 practising health visitors.

Almost half of those asked (48 per cent) say they feel so stretched that they “fear a tragedy where they work” meaning “vulnerable children are slipping through the net.”

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• The voice of health visiting: Cheryll Adams, executive director, Institute of Health Visiting

• Health visitors: five key changes

Latest NHS figures show that one in four health visitors were lost between 2015 and 2019.

According to NHS Digital, there were 7,694 health visitors in England in 2019, a drop of 25 per cent since numbers topped more than 10,000 in 2015.

The report states that almost a third of health visitors say they are now responsible for between 500 and more than 1,000 children, despite IHV guidance recommending 250 children per health visitor as the maximum number for work to be fully effective.

Such high caseloads left 58 per cent of health visitors reporting they worked out of hours and were feeling “tense”, “worried” and anxious.

One told the IHV: “I have taught myself to become numb to what is happening within health visiting as a coping mechanism.”

Overstretched health visitors reported being unable to carry out elements of their job despite them being mandatory or in line with official guidance.

Only 34 per cent said they were able to offer an antenatal contact to families, while 81 per cent are not conducting 12-month reviews of children and 90 per are not completing the two to two-and-a-half-year review. 

The IHV has called on the government to provide ringfenced funding for health visitors, introduce statutory protection for the health visitor roles and implement a new workforce strategy for health visiting with a focus on improving the quality of services for families, regardless of where they live.

Dr Cheryll Adams, executive director of IHV, said: “It is absolutely unacceptable that many families are struggling through the significant demands of early childhood without the vital support they need and are entitled to through the government’s flagship Healthy Child Programme”.

She added cuts to services had “left the government’s pledge to give every child the best start in life in tatters”.

The report comes amid plans by Oxleas NHS Trust and Greenwich Council to discontinue the borough’s Family Nursing Partnership from 31 March.

The partnership provides intensive care for teenage mothers who give birth up to the age of 19 until their child is two.

The GMB and Unite unions claim that dissolving the service would  “leave at risk teenage mums and their offspring without the help they need.”

The unions are calling for a meeting with the council and NHS bosses over the future of the service.

Oxleas NHS Trust said its current contract to deliver health visiting services in Greenwich will end on 31 March, meaning the trust is "unable to continue delivering health visiting services (including the FNP programme) in Greenwich from 1 April 2020." 

A spokesperson said the trust's bid, in partnership with other organisations, to run the council's Start Well Greenwich programme, which will include health visiting services for families and children under five in the borough, had been unsuccessful.

"We are currently working with Greenwich and the new provider, as well as our staff and local families, to make the transition as smooth as possible," they said.

A spokesperson for Greenwich Council said: “After reviewing the Family Nurse Partnership (FNP), which forms only part of our current overall health visiting offer to young parents, it was found that an enhanced service that delivered more intensive support was possible. 

“Start Well Greenwich, the proposed replacement programme, is an integrated service that incorporates children’s centres and health visitors, which will broaden our current provision to include vulnerable young parents who have been missing out on the service. The offer will be extended to last until children start school and support will be embedded within families’ communities.

“Ensuring families and young people have easy access to appropriate support is a key priority for Royal Greenwich as we recognise the vital importance of providing children with a strong life foundation. This is why we are improving upon the current provision for teenage parents to ensure they have the best start in life.”