Health visiting ‘in meltdown’

The health visiting profession in England is once more in crisis with all the negative impact on the physical and mental well being of families and children, some of them living in very vulnerable circumstances.

The high water mark for health visiting came in October 2015 when health visitor numbers peaked at 10,309 full time equivalents, following the national health visitor implementation plan instigated by the coalition government.

Since then there has been a sorry tale of decline with a 20 per cent drop in health visitor numbers. There were 8,244 full time equivalent health visitors working in the NHS (December 2017), which is the lowest number since August 2013.

Behind these bald figures, there are human stories of distress as health visitors, stretched wafer thin, struggle to deal with cases of postnatal depression and possible domestic abuse.

Our argument is that prevention is a better policy than allowing the NHS to be overwhelmed tomorrow because nothing has been done today.

It is time for a dramatic sea-change in government policy and Unite, with 100,000 members in the health service, is calling for a three-pronged approach by the health and social care secretary Matt Hancock, including:

• reinvesting in health visiting services
• revisiting the commissioning of health visiting services from local authorities, which have been under the financial cosh since the Tories came to power in 2010. The case for ring fencing council public health budgets is strong.
• restoring the bursary for health students so those eager to enter the 150-year-old profession don’t have to rack up ruinous loans.

The main reason behind the fall in health visitors is the slashing of council funding by the Tory chancellors George Osborne and Philip Hammond which means the services they commission have been redesigned to reduce cost. This has led to health visitor posts being axed.

A key example of this pernicious trend is what is happening to health visiting services in Birmingham which are in meltdown, following a damning review by the independent regulator the Care Quality Commission (CQC).

Birmingham Community Healthcare Trust, where Unite has 600 members, has been told by the CQC to make ‘significant improvements’ in the quality of its healthcare by March next year.

Unite, which embraces the Community Practitioners’ and Health Visitors’ Association (CPHVA), said that since the warning notice was delivered to the trust’s chief executive Richard Kirby in August (2018) a veil of secrecy had descended  about what steps the management is taking to rectify the situation.

The CQC review highlights that the average health visitor caseloads per whole time equivalent post is about 500 families at this particular trust – double the 250 figure recommended by the CPHVA for safe and effective practice.

On a general note, the cuts to health visitors across England come at a time when families need support more than ever as the impact of the government’s austerity agenda continues to seriously erode the services for children.

Unite will continue to protect its members in the face of extreme difficulties and challenges to their professional practice. We have been overwhelmed by the passion and courage of health visitors speaking out for families and children, in an environment where their concerns are not acted on as swiftly as they should be by management – sometimes the voicing of these legitimate fears go unheeded altogether.

Public Health England has recently released the Health Profile for England 2018. This pinpoints what happens during pregnancy and the first year of life influences physical, mental and emotional development in childhood, which, in turn, can have an adverse impact in adult life.

In the light of Public Health England’s report, Unite will be campaigning strongly into 2019 to restore health visiting to its rightful place as a fully resourced praetorian guard for public health for the benefit of families and children.

·         Jane Beach is a Unite lead professional officer and Su Lowe is a Unite regional officer in the West Midlands.