Children are being put at risk due to cuts in the number of health visitors and spiralling caseloads, according to the latest annual survey by the Institute of Health Visiting.
The 2017 survey of more than 1,400 health visitors in England found more than one in three fear they are so over-stretched that there may be tragedy in their area at some point.
“Many families see a health visitor only until their child is eight weeks old, with less skilled staff carrying out later reviews”
This is up from a quarter in 2015 and suggests “a very unsafe situation for both children and health visitors, who have to manage that risk and worry, and know they may be blamed if a child is injured”, according to the IHV.
The survey shows more than one in five – 21% – health visitors are working with caseloads of over 500 children, up from 12% in 2015 when funding for children’s public health services transferred from the NHS to local authorities.
At the time of the transfer in October 2015, a recommended minimum number of three full-time equivalent health visitors per 1,000 children was set.
However, the IHV recommends an average of one health visitor to 250 children to deliver “comprehensive” health improvements.
The institute said it was “very anxious” about the speed at which local councils were reducing health visitor posts. It claimed many were using less qualified support workers to carry out mandatory health checks more cheaply.
More than half – 51% – of health visitors who responded to the survey reported cuts to health visitor posts while 16% said there team had been reduced. Others said posts had been frozen and students were not being taken on. Only 22% said there had been no cuts where they worked.
The survey indicates that the ability of health visitors in England to provide all five mandatory checks to families before their children reach the age of two and a half is now “seriously reduced”, said the IHV. It suggested the checks were being passed on to less qualified staff or not done at all.
More than 90% of survey respondents said all families received a visit just after a baby was born. However, only 76% reported all families got a visit at six to eight weeks while only around two thirds – 67% – provided a nine to 12 month developmental review and about the same proportion offered a two-year check.
Less than a third provided an antenatal visit to all families and just 12.5% said they could offer a three to five month maternal health assessment, as advised by the National Institute for Health and Care Excellence – down from 25% in 2015.
“Health visitors’ time is being targeted to picking up work once done by social workers in some areas of the country”
Many said their role was becoming increasingly targeted, focusing on vulnerable families with 42% reporting they can only offer continuity of care to vulnerable children and those subject to child protection processes.
In all, 62% said focusing only on those most at risk was the biggest barrier to making a difference to families.
Cheryll Adams, executive director of the IHV, said the survey findings showed many health visitors were no long able to deliver a complete service to all families.
“We are being told that many families see a health visitor only until their child is eight weeks old, with less skilled staff carrying out all their later developmental reviews,” she said.
“Health visitors’ time is being targeted to picking up work once done by social workers in some areas of the country, meaning that these health visitors are not able to deliver their primary preventative role – the only professionals previously able to offer this as a universal service,” she added.
“Councils are having to carefully consider how best they can spend their public health funding, which has been cut by £531m”
She warned that cutting the public health workforce was a “false economy” because problems could escalate.
“Our worry is that the number of children needing care proceedings will increase, even more children will need mental health services, postnatal depression will go undiagnosed, there will be greater demand on GPs and hospital services and more children will enter school less well prepared in terms of their social, emotional and communication skills,” she said.
Izzi Seccombe, from the Local Government Association, which represents councils, said: “Councils are having to carefully consider how best they can spend their public health funding, which has been cut by £531m from 2015-16 to 2019/20 by central government, to maximise cost effectiveness and improve health outcomes.”
“However they are committed to improving the health of children and young people, and this area makes up the largest area of public health spend,” she added.
She said councils had been transforming services based on local need since the commissioning of public health transferred over to local authorities in October 2015.