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Health visitors 'deserve a space back in the NHS', say leaders

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The upcoming NHS England 10-year plan will fail if health visitors continue to be sidelined from the system as a result of being solely commissioned by local councils, leaders have warned.

In a firm position statement, published this week, the Institute of Health Visiting (iHV) called for the profession to be welcomed back into the “NHS family of nurses” through a joint commissioning approach, in order to give every child the best start in life.

“It will be impossible to deliver on many of what we expect to be its worthy ambitions”

Cheryll Adams

The 10-year plan is be released later this year but NHS England chief executive Simon Stevens has already identified children’s services, mental health and health inequalities as some of the key priorities.

The iHV said it believed that health visitors could play a part in achieving these ambitions – with the right funding, training and support.

Commenting on the position statement, iHV executive director Dr Cheryll Adams said: “Health visitors have a vital role in delivering early preventative services for infants and children, and in supporting parents through the emotional challenges of early parenthood.”

Cheryll Adams

Cheryll Adams

Cheryll Adams

“Unless there is a plan to strengthen health visiting services alongside the new NHS 10-year plan, it will be impossible to deliver on many of what we expect to be its worthy ambitions,” she said. 

“We hope that our rationale, and the recommendations in our new position statement, will be taken seriously by those writing the plan,” Dr Adams added.

In October 2015, commissioning of health visiting was transferred to local authorities.

The iHV claimed health visiting has subsequently become “severely challenged” and has experienced a 20% drop in workforce in the wake of public health budget cuts to councils.

The move also meant services for families have become “fragmented”, and health visitors have lost vital links with NHS partners, it added.

The report stated that health visiting had become “practically invisible in the NHS landscape”, since the focus had shifted to older-adult health and social care due to an ageing population.

There needs to an “equivalent sense of collective urgency” on the health and wellbeing of children and families, it urged.  

The iHV is calling for health visiting to be jointly commissioned and governed by both the NHS and local authorities, as part of emerging forms of integrated care systems and sustainability and transformation partnerships.

iHV wants to see health visitors given resources in the 10-year plan to take a specific lead on:

  • Infant and perinatal mental health;
  • Oral health;
  • Promoting good nutrition;
  • Improving the home learning environment including speech, language and communication skills in pre-school age children;
  • Addressing child safety for the first 1,001 days;
  • Supporting the health needs of the most marginalised and vulnerable children.

Currently, families in England receive a minimum of five reviews with a health visitor in the early stages of a child’s life as part of the Health Child Programme (HCP). The iHV is calling for this to be increased to at least nine.

Dr Adams said: “This requires new investment into the profession, but that will be more than offset by savings in preventable treatment costs in later life.”

The report suggests health visitors are well equipped to deliver the entire scope of the HCP with the right investment.   

In the conclusion, the report said planning for the next 10 years of the NHS “affords the opportunity to establish a national quality framework for systems-based practice for child and families public health to realise the benefits of integration of health visiting with both the NHS and local authority services and the wider landscape of provision”.

Dr Adams said the position statement had been circulated widely to decision makers.

The report stated there should be a similar investment plan for school nursing. 

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