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Health visitors fear child tragedy

Four in 10 health visitors fear a child tragedy at some point because they are so overstretched, a survey has revealed.

Over 1,200 English health visitors responded to the 2018 Institute of Health Visiting (iHV) annual survey and 43% reported 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.”

Health visitors reported that their caseloads are increasing, they are experiencing high levels of stress, and they worry about not being able to deliver the services they should to all children with needs, especially the most vulnerable. This follows a significant reduction in local authority public health funding since 2015.

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

Higher caseloads have resulted in 42% of health visitors reporting the quality of their service as being inadequate or poor with 72 per cent citing increased stress levels.

Health visitors also report working with many more families facing multiple adversities, including parental substance misuse, domestic abuse and mental illness. There is also increasing need especially related to poverty with 69% of health visitors saying they had seen an increase in the use of food banks over the past two years.

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 (HCP) in England, the minimum service that every family is entitled to, has been seriously reduced. Many reviews are delegated to non-registered practitioners without health training, and some are not carried out at all.

Dr Cheryll Adams CBE, Executive Director iHV, said: “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 Children’s Commissioner for England has recently discussed the need to be concerned about so called ‘missing babies’ (A Crying Shame, Oct 2018) who are very vulnerable but not recognised as children in need and only found if you look for them," she added.

The Institute is urging 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.”

iHV State of Health Visiting Survey 2018 report

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