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Health Visitors Report Widening Health Inequalities

Editor's note: This article was updated with quotes from the Royal College of Paediatrics and Child Health

More babies and young children are missing out on the Government's promise of the 'best start in life' say the authors of the latest health visitor survey.

"Widening health inequalities and escalating levels of population need – including parental stress and mental health problems – pose serious risks to children's future health, development, and wellbeing,” warned Alison Morton, executive director of the Institute of Health Visiting.

The stark findings from the largest survey of frontline health visitors working with families across the United Kingdom, described a "deteriorating picture of a health visiting workforce under immense pressure", as practitioners struggle to meet the scale of rising need.

Dr Camilla Kingdon, president of the Royal College of Paediatrics and Child Health, said that the findings of this year's survey were a "harrowing" read and that the  situation remains "dire" for many babies, young children, and their families.

The report, which included responses from 1323 practitioners working in health visiting between 26 September and 2 November 2022, highlighted that "epidemic" levels of poverty as well as parents struggling under the weight of the cost-of-living crisis was forcing parents to turn to food banks to feed their children. Alongside this, more parents were living with mental health problems, domestic abuse, and adversity, which posed risks to the health and wellbeing of babies and young children.

Specifically, the report found:

  • 91% of health visitors reported an increase in poverty affecting families over the past 12 months
  • 91% reported an increase in families needing foodbanks
  • 83% reported an increase in perinatal mental illness
  • 75% reported an increase in domestic abuse

Children Missing Out on Vital Health and Development Reviews

The authors highlighted that there are "insufficient" health visitors to meet the scale of rising need. In England, there has been a loss of almost 4 in 10 health visitors since 2015, which equates to a shortfall of 5000 health visitors, the authors pointed out. This meant that 1 in 5 children in England were "missing out" on vital health and development reviews, they said, with only 1 in 8 (13%) health visitors in England able to deliver antenatal contact to all families, and only 54% able to deliver the 6-8 week' postnatal review to all families.

Ms Morton commented that the experiences presented provided an important "early warning signal" of the most pressing threats and challenges to the health and wellbeing of babies and young children, which are "often hidden behind front doors and invisible to other services".

The report also highlighted that health visitors had witnessed the impact of various problems on the safety, health, and development of babies and young children. More than 8 in 10 (84%) health visitors reported an increase in children with speech, language, and communication delay; over 3 in 4 (76%) reported an increase in child behaviour problems, and almost half (48%) reported an increase in child development problems. In addition, 6 in 10 (60%) health visitors reported further increases in child safeguarding needs over the last 12 months, on top of those from the previous year.

Health Visitors Worried, Tense, and Anxious

The report's authors commented: "As health visitors often work alone, or in small teams in families' homes, their work is often hidden and it’s easy to overlook how important it is."

Ms Morton added: "Families are facing the brunt of these challenges with a widening postcode lottery of health visiting support across the UK." Regarding continuity of health visitor, only 3% of health visitors in England said they achieved this, which contrasted with 88% in Scotland, 87% in Northern Ireland, and 80% in Wales.

Only 7% of health visitors in the UK felt confident that all families would be able to access the support they needed when a problem was identified, and 86% reported that there was not enough capacity in other services to pick up referrals for support and treatment.

Many respondents reported work-related stress and burnout with reduced job satisfaction, and 70% reported feeling "worried, tense, and anxious".

'Tsunami' of Unmet Need

"Unmet need in health visiting services have been overlooked within a 'baby blind spot' in national policy which will leave equally serious challenges for both mental and physical health for babies, children, and families across the UK, now and in years to come," cautioned the authors.

The authors emphasised that the "responsive, real-time data" presented in their report was a "gift to policymakers". However, they warned that it will take "many months, if not years", before the longer-term impacts on health and wellbeing are visible in any national dataset.

Ms Morton added that ignoring the "tsunami" of unmet need risked undermining the life chances for children.

"In England, the Government categorised health visiting as 1 of 6 priority services in its Start for Life Vision for the first 1001 days. However, this commitment is at risk without investment and a plan to rebuild the health visitor workforce, she said.

Dr Kingdon warned that without further support and focus, "We are fast approaching a crisis in child health".

"It is not too late to change direction and pursue reforms, but the situation is serious," Ms Morton stressed.