Health visitors have found it “incredibly disappointing” that the government has decided not to increase the number of visits young children should receive as a legal requirement in England, despite strong support for the change, according to a leading organisation representing the specialty.
The Department of Health announced this month that legislation would remain in place that requires families with babies to receive at least five health visitor checks before the child reaches the age of two and a half years old.
The law was brought in when local authorities took over responsibility for commissioning health visiting services from the NHS in October 2015. It was designed to ensure recent boosts to the service – following a 50% increase in the workforce – were maintained, but was due to expire at the end of March.
The five checks take place during the mother’s antenatal period, in the first two weeks of birth, eight weeks after birth, at 12 months and when the child reaches two and a half years old.
But a review of the legislation’s effectiveness by Public Health England showed there was significant support among health visitors, and to a lesser extent among local councils and employers, for an extra visit to be made a legal requirement – when the child reaches three to four months old.
“Some suggest that 3-4 months is a better timing for assessing a mother’s mental wellbeing”
Public Health England review
Almost 50% of the 3,130 health visitors taking part in PHE’s review wanted the law to continue but in a revised form and the most sought-after change – in around half of all responses – was for an extra visit at three-to-four months to be added.
Around 40% of local authorities and a similar proportion of health service organisations also wanted changes to the law, with the three-to-four month check among the two most favourite options.
There was “some concern that 6-8 weeks is simply too early for an effective maternal mood assessment. Some suggest that 3-4 months is a better timing for assessing a mother’s mental wellbeing as well as ideal timing for discussions on weaning and healthy eating,” said the review.
Meanwhile, among the other 50% of health visitors who said they wanted to see the law continued as it currently is, the most popular reason cited was because they believed five visits was the minimum standard.
In addition, the PHE review revealed that, while there had been “overall improvement” in the number of visits being provided since before the law was introduced, “service levels still fall short of covering all children and do vary significantly from one part of the country to another”.
“If it had been added in the local authorities probably would have had a lever to lobby for more public health funding”
The head of the Institute of Health Visiting said it was “incredibly disappointing” that the sixth extra check had not been made a statutory requirement, because one at around this time was a core part of the national framework for services.
She suggested that if it had been mandated, local councils would have had grounds to campaign for more public health funding from the government to ensure the checks took place, and could also have prevented future health problems.
“It probably came down to money and, if it had been added in, the local authorities probably would have had a lever to lobby for more public health funding to deliver on it,” said Cheryll Adams, executive director of the IHV.
“The fact is, the five mandated contacts are an absolute minimum… At the end of the day it’s about public health outcomes and three to four months is a critical point to be contacting every family,” she said.
“It is an opportunity to have conversations about nutrition, which may reduce obesity, to discuss accidents for babies that are beginning to get more active, and to discuss or identify perinatal mental health issues as it’s a key time for picking these up,” she said.
”Parents may have suffered from a relentless lack of sleep too and at some point it comes to a head and will challenge many couple relationships” she added.
Ms Adams said that without mandation there was no pressure on councils to commission a visit at this time. She urged them to consider the important public health benefits and to ensure services included the extra check.
Nursing Times contacted the Department of Health for comment but has so far received no response.