The number of health visitors working in the NHS in England has fallen by almost 9% in the space of a year, leading to warnings by senior nurses that the workforce could soon return to previous dangerously low levels.
New analysis by Nursing Times of the latest official data has revealed NHS school nurse numbers have also dropped by 6% in the same amount of time.
“This drop in numbers demonstrates a failure of this government to follow through on its commitment”
The reduction in staffing levels has taken place in the 12 months since the commissioning of public health services fully transferred over to cash-strapped local authorities, in October 2015.
The data appears to confirm fears that ongoing cuts to council public health budgets by the government are leading to a significant reduction in nurses working in children’s services.
According to the latest NHS Digital data, in October 2015 there were 10,309 whole-time equivalent health visitors working in the NHS – the highest level recorded for over a decade.
But by October 2016 there were just 9,410 WTE health visitors working in the NHS – an 8.7% drop, equal to a loss of 899 posts.
“There is a very real risk health visiting numbers could fall – in terms of ratios of staff to children – to where they were in 2010”
At the same time, there was a 6% reduction in the number of WTE school nurses working in the NHS, down from 2,725 in October 2015 to 2,561 a year later.
NHS health visitor staffing levels have been falling almost consistently each month since the high-point in October 2015 – and from March 2016 onwards the numbers were lower than the same time in the previous year.
Similarly, in every month between October 2015 and 2016 there have been fewer school nurses than the same time the year before.
In 2010 the Conservative Party committed to increase the size of the health visiting workforce in England by more than 50% over five years, due to concerns over staffing levels.
By March 2015 it had almost reached its target and there were 12,077 WTE health visitors in the workforce, with around 85% of these working for the NHS, and the rest based with other independent organisations.
But senior public health nursing leaders said the fall in NHS health visitor numbers in the past year showed the government had failed to deliver its commitment to increase support for children and young people.
They said cuts to local authority public health budgets were putting a strain on services, causing employers to in some places cut jobs and in others prompting staff to retire or leave for other parts of the profession.
They warned that further reductions to the NHS health visiting workforce could, in the space of another 12 months, lead to the same unsustainable staffing levels seen almost a decade ago.
Dr Cheryll Adams, executive director of the Institute of Health Visiting, said: “This happened 10 years ago. In 2005 when cuts in health visiting started to happen across the country, a lot of capable health visitors said, ‘actually I really can’t go to work and hold a caseload that is so large and feels unsafe’. So they went off sick or looked for other jobs. That will be starting to happen again when cuts are planned.”
It was even more of a risk if the government failed to continue to make it a legal requirement for all children to receive five health visitor checks before the age of two and a half years old, said Dr Adams, referring to a review of legislation that is due to expire next month.
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“If the legal requirement comes off it opens the gate to local authorities making local decisions around however they want to design the health visiting service,” said Dr Adams.
“The sorts of decisions that are being made are based, in some cases, on the thought that in integrated children’s services, non-registered professionals could take on more of the health visiting role,” she warned, noting it was government cuts to public health budgets that were creating challenges for councils.
Dr Adams added that services could not afford to lose recent boosts to the health visiting workforce, because birth rates had risen “dramatically” in the past decade. She also noted another “big issue” was the declining number of nurses taking up health visitor training places.
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“If you look at some of the plans by local authorities, and if the legal requirement for five checks is removed, there is a very real risk health visiting numbers could fall – in terms of ratios of staff to children – to where they were in 2010. And it could happen in the next 12 months,” she said.
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Dame Professor Donna Kinnair, director of nursing, policy and practice at the Royal College of Nursing, echoed such concerns, stating that cuts to local council public health budgets were causing services to suffer.
“This drop in numbers demonstrates a failure of this government to follow through on its commitment to increasing the number of health visitors to 12,000 for children and young people, as these services have borne the major brunt of public health cuts,” she said.
“The importance of health visitors and school nursing should not be underestimated, as supporting children and their families in the early years avoids the taxpayer, the child and their families paying for unidentified health and social care concerns later in that child’s life,” added Ms Kinnair.
While these figures do not show how many health visitors and school nurses are working for non-NHS employers, Ms Kinnair noted the drop was concerning because it was unlikely that all were now working for independent organisations, which in any case had to operate within challenging budgets set by local councils.
“We are investing £16bn during this parliament to make sure local services, including health visitors, are in place”
Department of Health
NHS Digital does collect some data on health visitors working in social enterprises and community interest companies, which also indicates a slight drop since 2015 – from 957 in September 2015 to 924 in March 2016.
Obi Amadi, lead professional officer at Unite’s Community Practitioners’ and Health Visitors’ Association, agreed that cuts to local authority budgets were leading to reduced services and causing staff to leave.
She noted training places for health visitors had not been filled in recent months, and that other changes to undergraduate nurse training also threatened to reduce the pool of staff who go on to post-registration training.
“We have real concerns that with the change to bursaries and introduction of apprenticeships, the workforce growth will continue to fall short of what is needed. Caseload sizes are increasing again - in some areas they were too high before these reductions so there are concerns about whether services are safe,” she said.
A Department of Health spokesman said: “These statistics do not include health visitors directly employed by local authorities and so are not an accurate picture of how many are currently working in England.
“We are investing £16bn during this parliament to make sure local services, including health visitors, are in place to support people in their communities.”
NHS health visitors: Oct 2014 to Oct 2016
NHS school nurses: Oct 2014 to Oct 2016