Health visitors in England are being called on by the government to help reduce the number of children from disadvantaged backgrounds who start school without basic communication skills.
Additional training is to be provided to 1,000 health visitors working in some of the country’s most deprived communities to recognise early signs of delays in a child’s speech and language and take action.
“There’s no way of doing things better without adding resources”
However, a union chief has warned that health visitors are already stretched to their limits and improvements to services will be difficult without extra resources.
The programme is part of the government’s drive against the so-called “word gap” – the difference in communication skills between disadvantaged children and their more privileged peers. Figures show children who start school with poor vocabulary are twice as likely to be unemployed as an adult.
The announcement comes just days after an influential group of MPs found health visitors shortages and unmanageable caseloads meant mandated contacts with families were being missed.
Latest figures show the number of health visitors in the NHS in England has fallen by 25% over three years, from 10,279 in November 2015 to 7,7780 in November 2018.
Obi Amadi, lead professional officer for health visiting for the union Unite, commended the ambition of the programme but said it needed to go hand-in-hand with increases in spending and recruitment.
“There’s no way of doing things better without adding resources and that is the stumbling block because whether it be better administration, better planning in terms of how services are delivered - something needs to be put in,” Ms Amadi told Nursing Times.
“One of the things that we think is the most effective is about having experienced health visitors out there doing the job and we are losing those experienced health visitors because they have had enough, because they are retiring, they are moving into doing other roles,” she added.
Ms Amadi said health visitors already covered speech and language but because they were so stretched many only had time to do the bare minimum to meet their statutory requirements.
She warned that adding more responsibilities may mean health visitors had to drop other important duties.
“The profession is valuing this high-level endorsement of their critical role”
Dr Cheryll Adams
“The unfortunate thing is that the likelihood is, because as we know numbers of health visitors and health visiting teams aren’t increasing….something has to go down the priority list, which is the thing that is of concern because everything that they do right now is a priority,” said Ms Amadi.
She added health visitor training had “fallen off the cliff edge” since the government’s health visitor implementation plan, which set out to increase the workforce by 4,200 between 2011 and 2015.
A health visiting apprenticeship is currently being developed in England. Ms Amadi said this would help but it would not be a silver bullet.
The new speech and language scheme is being jointly led by the Department for Education and government arms-length body Public Health England, with training being delivered by the Institute of Health Visiting.
The first wave of training will involve 400 health visitors in 49 council areas identified as being in high need, based on deprivation factors including free school meal eligibility and the level achieved in speech, language and communication among children aged five in the “early years foundation stage profile”.
The next wave will train a further 600 health visitors from 2020 onwards.
As part of the initiative, health visitors in five areas of the country – Derbyshire, Newham, Middlesbrough, Wakefield and Wiltshire – will trial an early language assessment tool being developed by the University of Newcastle, led by Professor James Law.
The tool will be designed to be quick and easy for health visitors to use to support their professional judgement, taking into account any concerns raised by parents and carers. It will be trialled for the first time this summer and rolled out nationally in 2020.
“Health visitors have trusted relationships with families”
Professor Viv Bennett
Professor Viv Bennett, chief nurse at Public Health England, said: “Health visitors have trusted relationships with families and play a vital role in supporting young children’s health and wellbeing.
“This important new training will help more children develop the language and literacy skills they need to reach their full potential, ensuring that specialist support gets to those that need it most,” she added.
Dr Cheryll Adams, executive director of the Institute of Heath Visiting, said a survey of health visitors carried out as part of this initiative found 98% would value evidence-based training in speech, language and communication.
“Promoting speech, language and communication is core to health visiting and the profession is valuing this high-level endorsement of their critical role,” Dr Adams said. “Equally, it builds on current practice and interventions with families.”
The training programme has been launched to support the government’s pledge to halve the proportion of children leaving reception without the communication, language and literacy skills needed to thrive within the next decade.
Children and families minister Nadhim Zahawi said: “Being able to communicate and express yourself is the gateway to success, not just in school but in later life.
“It’s these crucial early years that make the most impact on a child’s future path – because for those children who start out behind their peers, it’s so much harder to catch up,” he said.
“The evidence tells us that we need to improve children’s communication and language before they arrive at school, when so much of a child’s time is spent at home, to help get them on track to be confident, able learners,” he added.
Survey: Health visitors called on to share their views
The Elizabeth Bryan Multiple Births Centre (EBMC) and Institute of Health Visiting are calling on health visitors to share their views and experiences of supporting multiple birth families in an anonymous online survey.
Birth records show that multiples births have increased over the past 20 years and around one in 64 pregnancies result in a multiple birth.
Despite this rise, few studies have investigated how best to support multiple birth families. Because of this, researchers at the EBMC are calling on health visitors to share their experiences through a study funded by the Burdett Trust for Nursing.