Profession under pressure

Overwhelming evidence proves that a child’s life chances are largely determined by what they experience between the ages of 0 and 5. If you’re a healthy, supported young child, you’ll be a healthy, well-adjusted adult.

That’s why health visitors are in many ways the hidden backbone of health care in the UK. As they support families, many of whom are already vulnerable, in caring for their young children, they’re laying the foundation for a healthy general public.

But if the government’s decisions governing health visitors are anything to go by, you’d think the profession is unessential, when in fact it’s anything but.

Last year, commissioning for health visitors was transferred from the NHS to local authorities. The logic behind this move was that local authorities better understood local needs.

But in practice, this means health visiting is exposed to local authority cuts that have been decimating council services up and down the country, with local authorities covering the most deprived areas being hit the hardest.

A letter published this week in The Times signed by leaders of health care unions and associations, including Unite lead professional officer Obi Amadi, explained how exposing health visiting to cuts is creating a dangerous false economy.

‘Irredeemable consequences’

“The loss of health visitors could have irredeemable consequences for children and families, stunting the progress of several government priorities, ranging from reducing the incidence of obesity and mental health issues (in children and adults) to promoting social inclusion,” the letter read. “Any money saved would be eclipsed by the resulting pressure on the NHS.”

It’s been less than a year since responsibility for health visiting was transferred to local authorities, just as public health budgets are being slashed after the government reduced its public health grant to local authorities for 2015/16 by £200m.

And in those scant 10 months, many local authorities have already moved to revise their budgets for health visiting, confirming the worst fears Unite and others have had ever since the government first announced in 2014 that health visiting would no longer be under the aegis of the NHS.

The Nursing Times reported that, for example, Barnsley Council in Yorkshire will later this year reduce the money it has set aside for health visiting by a full ÂŁ1m, from ÂŁ5.8m to ÂŁ4.8m.

The London boroughs of Lambeth, Southwark and Bromley are all reviewing their children’s services, too, with Lambeth and Southwark Council both cutting funding for health visiting at Guy’s and St Thomas’ NHS Foundation Trust.

Earlier this year, the Foundation Trust confirmed it would have to reduce health visiting posts in response to cuts that would be implemented in July.

More recently, Lewisham Council in London is bracing itself for a massive ÂŁ4.7m reduction in its public health budget next year and is now seeking savings of ÂŁ2m from existing health visiting and school nursing services.

The Save Lewisham Hospital Campaign has now launched a petition against the cuts and is urging local residents to participate in the council’s public consultation.

“Children’s services are not some non-essential, ‘cuttable’ part of the local health service,” the Lewisham campaigners note. “They are central to protecting our most vulnerable children from disease and neglect. They provide the bulk of our safeguarding and public health commitments, from cradle to adulthood.”

Impossible pressure

As health visiting cuts tear into communities and decimate the service, health visitors now working are facing ever larger workloads, impossible pressure and demolished pay, terms and conditions – a situation that’s been exposed by a recent survey published yesterday (August 16) by Unite, which embraces the Community Practitioners’ and Health Visitors’ Association (CPHVA).

Nearly 60 per cent of health visitors surveyed reported big increases in individual workloads compared with the previous year, and 44 per cent of health visitors reported a slump in morale/motivation in their workplace, with the vast majority attributing the drop to increased workplace stress.

The survey confirmed that cuts to health visiting have had a decided impact on staff supply, with 70 per cent recording ‘frequent’ staff shortages in their workplace in the last 12 months.

Eighty six per cent say that they ‘always’ or ‘frequently’ work more than their contracted hours, with 71 per cent saying this means more than two hours each week and 31 per cent doing more than four.

More than half of the health visitors surveyed – 62 per cent – said all their overtime was unpaid. 53 per cent reported reductions in their terms and conditions, with the majority reporting changes to sickness entitlement.

Health visitors also anonymously expressed what they had to contend with.

“I qualified as a health visitor last year following the HV initiative plan,” one health visitor explained. “I now find my job at risk as posts are being cut and people downgraded.”

“I feel deeply disappointed that my role has become a ‘target driven’ one with little time for quality client contact,” another said. “Health Visiting should be about quality and not quantity and this is sadly no longer the case.”

One health visitor noted as the student health visitor salary has dropped, the profession is “unlikely to attract experienced practitioners which health visiting needs.”

“I can see a day coming when qualified health visitors will be put on a lower banding,” they added. “New staff go on terms and conditions which mean less leave, less sickness. It all feels quite demoralising and I am thinking of retiring early next year.”

Stress

Unite national officer for health Sarah Carpenter noted that the picture that emerges from the survey is one in which “health visiting is a profession under a great deal of stress as health visitors juggle increasing demands on their vital services with decreasing resources and contracting pay packets.”

“Ministers need to wake-up to the fact that the progress made by the last government with the Health Visitor Implementation Plan, which boosted the workforce by more than 4,000, could be jeopardised with all the adverse impact this would have on families, children and the wider public health agenda,” she added.

“The situation is further eroded by savage cuts to local government which now has the responsibility for health visiting budgets.

“Despite indications from health secretary Jeremy Hunt that he wants to keep a firm lid on NHS pay, the argument for a decent pay rise for the NHS workforce, which has seen their income in real terms drop by more than 15 per cent, is irrefutable. This health visitor survey strongly reinforces this case.”

Unite lead professional officer Obi Amadi agreed.

“Government decisions regarding health visiting have turned into nothing but a vicious cost-cutting exercise, and we’ve seen the impact this has had on the workforce from the survey,” she said. “They’re overworked and so aren’t able to properly care for the children and families as they would under normal circumstances.

“We also have to understand that we’re actually at a very early stage in the cuts,” Amadi warned. “There are many more cuts to come and things will only get worse.”

She said that Unite is calling on the government to take a “common sense approach”.

“We’re talking about young children under the age of five who will be most damaged by these decisions – they are the future of our country,” she said.

“If we get these decisions wrong, it will have an impact on everything from social care, hospital care, treatment for chronic conditions, and even the criminal justice system will be hit – the costs to the public purse are only going to increase exponentially.”

@hajera_unite

Are you a health visitor or community practitioner under pressure? Would you like to tell us your story? Please contact us at unitelive@unitetheunion.org