Families missing out on health visitor checks

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A survey of health visitors suggests that more than a quarter of families do not receive health visitor reviews, and highlights a large rise in health visitor caseloads.

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Health visitors carry our five checks with families

The survey by the Institute of Health Visiting of 1,200 health visitors said that government cuts to local authority budgets have impacted on the delivery of the universal health visiting service.

Currently, health visitors carry out five mandated checks: one antenatal check, one straight after birth, one at six to eight weeks, one at one year and one at between two and two- and-a-half years.

Local authorities took on responsibility for under-fives' public health in 2015 and are legally required to commission the checks.

However, this is currently being reviewed by the Government and a clause enforcing this requirement comes to an end in March 2017.

According to the IHV survey, 70 per cent of all families receive health visitor reviews after their child’s birth. Just 30 per cent of all families received the antenatal visit. 

Eighty-five per cent of health visitors surveyed felt their workload had increased in the past two years. Forty per cent of the increase was attributed to a loss in the number of health visitors. This is despite huge investments that went into the service between 2012-15, the IHV said.

Sixteen per cent of health visitors reported they were having to look after between 500 and 1,000 children, when the recommended average caseload for safe and effective practice is 250. 

Official NHS figures, published in 2016, show that at least 988 full-time health visitor posts were lost between September 2015 and August 2016.

Dr Cheryll Adams, executive director of the Institute of Health Visiting, said, ‘Our annual survey revealed the impact the first cuts to the local authority public health budgets are already having on the universal public health services delivered by health visitors, and with more cuts due this is enormously worrying.

‘Our health visiting service has been the envy of the world, but it’s very viability in some areas of England is now once again under threat, unlike in Scotland, Wales and Northern Ireland where it is being strengthened.

‘Research evidence demonstrates that investment early in life reduces the fiscal spend later (Marmot, 2010, LSE, 2016) and reduces health inequalities, one of the Prime Minister’s ambitions. Health visitors are advanced-level public health community specialists; once posts have been lost it will take many years to rebuild the profession.  We hope that the government will be as concerned as we are and take action to stop this situation worsening.’

A spokesperson for Public Health England said, ‘I’d like to point out that these [Institute of Health Visiting] findings are based on a survey, whereas PHE collects data from local authorities. The latest 2015/2016 quarterly data shows that 80.4 per cent of six-eight week visits were delivered. For the 12-month review is it 80.8 per cent and for the two- to two-and-a half year review it is 81.8 per cent.’

Professor Viv Bennett, chief nurse at PHE, said, ‘Our aim is to ensure every child is ready to learn at two and ready for school at five. Universal health visitor reviews are important for assessing the health and development of babies and children, giving all parents support and identifying early on where families need extra help. We are working closely with local authorities to provide evidence, professional leadership and guidance to help health visitors meet their public health responsibilities.’

Meanwhile, a separate report from the Social Mobility Commission, published at the end of last year, reflects many of the concerns identified in the IHV survey.

It found that one in four babies born in the UK are not receiving checkups from health visitors that local authorities are obliged to offer during the first two years of their life.

A fifth of babies do not receive the recommended reviews after they turn one, and one in four miss out at the age of two. One in five children had not received the 12-month check by the time they reached 15 months old.

It is up to parents whether they want to take up any offered assessment of their child’s health and development.

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