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Health visitors fear staff shortages mean another child tragedy is ‘waiting to happen’

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Health visitors have voiced fears of child tragedy as a result of increasing caseloads and high levels of stress, revealed a survey.

The 2018 Institute of Health Visiting (iHV) survey found that many reported rising caseloads, high levels of stress and were worried they would not be able to help children in need due to stretched services.

“It is about much more than the number of contacts, it’s the quality of those contacts that matters”

Cheryll Adams

Out of over 1,200 English health visitors who participated in the survey, 44% reported they are working with caseloads of more than 400 children, despite the institute recommending a maximum of 250 children for a safe service.

This figure has increased from 28% in the same survey in 2015, when commissioning of their service transferred from the NHS to local authorities.

Higher caseloads have also led to 42% of health visitors reporting the quality of their services as being inadequate or poor.

In addition, 72% reported that their stress levels have gone up, with the main reasons being long hours and feeling worried about the safety of their vulnerable clients.

Meanwhile, 45% said they had experienced a change of employer in the last year or expect to do so in the next year, which in turn, added to workplace uncertainty and stress, reflected in rising sickness-absence rates.

“It is clear there is now a significant postcode lottery of health visiting services across England”

Cheryll Adams

Survey respondents also said they have concerns about the safety of a child, where a shocking 43% reported they are so stretched they fear a tragedy at some point- when a child in need isn’t recognised until it’s too late.

Dr Cheryll Adams, executive director iHV, said: “Cuts to public health budgets by the Treasury have led to a loss of around a quarter of the total health visiting workforce over the past three years, but these losses aren’t consistent across the country with losses being greater in some areas and smaller in others.”

The losses come against a backdrop of increasing need, especially in terms of poverty. In the survey, 69% told the institute they had seen an increase in the use of foodbanks over the past two years.

One health visitor said: “Complexity of families and increase in poverty has increased need, especially around mental health.”

The practitioners also reported working with families with multiple adversities such as parental substance misuse, domestic abuse and mental illness.

Respondents have said they have concerns about couple’s relationships and high levels of domestic violence, but only 10% can support couple relationships.

“Health visitors play a vital role in public health and prevention”

Russell Viner

In addition, it was reported that around 65% families did not have an appointment with a trained health visitor after their child’s 6-8-week contact, and even less, 79%, after the first year of a child’s life.

Following the change to authorities in 2015, arrangements made it clear that health visitors in England were best placed to carry out five mandatory checks.

However, responses from the practitioners also indicated that their capacity to deliver all five-mandated universal health and development reviews from the Healthy Child Programme – the minimum service families are entitled to- has been seriously reduced.

The survey found that many reviews were delegated to non-registered practitioners without health training, while some are not carried out at all.

Speaking on the issues concerning the five-mandated contacts, Dr Adams 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,” she said.

England has just five mandatory universal contacts prescribed for all families – the least among the health visiting services across the UK.

Nine core universal contacts are being delivered to Welsh families, seven in Northern Ireland – with a plan to increase to nine – and Scottish families receive 11.

Cheryll Adams

Cheryll Adams

Cheryll Adams

Dr Adams added: “It is about much more than the number of contacts, it’s the quality of those contacts that matters – having enough time to listen to family concerns and to act on them.

“It is clear there is now a significant postcode lottery of health visiting services across England with some parents still receiving a good service (for example, Blackpool has invested into eight contacts) on a sliding scale to many parents receiving very poor services depending on where they live,” she said.

“This is an unacceptable situation for English children as it has implications for their wellbeing across the life course,” warned Dr Adams.

The institute’s report claimed health visitors were now “walking a very tight rope” between being strongly driven to meet the five mandated contacts on the one hand and children protection social work-by-proxy on the other.

Professor Russell Viner, president of the Royal College of Paediatrics and Child Health, 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,” he said.

The institute is calling for 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 warned that unless the round of public budget cuts, due in 2019-20, were stopped, there will be a further reduction in health visitors meaning more negative outcomes for children and families.

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