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Health visitors warn of rise in caseload and fall in staff

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The impact of cuts to council public health budgets is laid bare in a survey of health visitors, which found only a tiny minority feel able to provide continuity of care to all families.

According to the survey of more than 1,200 health visitors by the Institute of Health Visiting, 85% have seen their workload increase in the past two years, with 40% of the increase blamed on a reduction in the number of health visitors.

“Once posts have been lost it will take many years to rebuild the profession”

Cheryll Adams

A significant proportion of respondents – 16% – said they now had caseloads of between 500 and 1,000 children, despite the fact the optimum average caseload for safe and effective practice is 250.

The cuts have affected the delivery of standard, universal health checks for young children, according to the report, with only 70% of families receiving mandated health visitor reviews for children at six to eight weeks, one year and at around the age of two and just 30% of families receiving an antenatal visit.

Just 5% of health visitors who took part in the survey said they felt able to deliver consistent continuity of care to all families, while 72% were worried about providing adequate safeguarding and child protection support.

Worryingly, 80% of survey respondents said they had seen an increase in domestic violence and abuse and perinatal depression in the families they visit.

Official figures show 988 full time posts were lost in England between September 2015 and August 2016, with 56% of local authorities planning further cuts next year.

The Institute of Health Visiting warned there would be a knock-on effect on the NHS and other council services such as child protection if health visiting services continued to be cut.

The institute’s executive director, Cheryll Adams, said local areas could expect to see increased use of hospital care and local authority children’s social services in the short, medium and long term – and an increase in health inequalities – because concerns would not be identified early.

Cheryll Adams

Cheryll Adams

Cheryll Adams

“Our annual survey of the state of health visiting shows a radical downgrading of this public health asset, which serves the most formative period of children’s lives,” she said.

“Health visitors should provide a universal service to every family in the country with a child under the age of five,” said Ms Adams.

“This survey exposes the risks to all children and families from a decommissioning of health visitor posts, which it seems is about to accelerate,” she added.

Ms Adams called on the government to reverse spending cuts “before further damage is done to children’s futures”.

“Our health visiting service has been the envy of the world but its very viability in England is now under threat, unlike in Scotland, Wales and Northern Ireland where it is being strengthened,” she said.

“Health visitors are advanced-level public health community specialists,” she said. “Once posts have been lost it will take many years to rebuild the profession.”

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