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Half of health visitors working with caseloads above recommended level

Almost half of health visitors in England are working with caseloads of more than 400 children – well above the recommended number of 250 – according to a new survey.

A significant proportion of health visitors admit to feeling so stretched that they fear a tragedy occurring – when a child in need isn’t recognised until it’s too late.

The survey by the Institute of Health Visiting (iHV) reported that 43% of more than 1,200 health visitors in England say they worry a tragedy could happen.

It also found that 44% of health visitors reported working with caseloads of more than 400 children, with 28% having between 500 and 1000+ children. This is up from 28% and 12% respectively in 2015, when commissioning of their service transferred to local authorities, and is well above the level of one health visitor to 250 children that the iHV recommends to deliver a safe service.

Higher caseloads have led to 42% of health visitors reporting the quality of their service as being inadequate or poor, with increased stress levels in 72% of practitioners. Sickness absence rates also increased in 2017/18 to 5.44% from 5.11% in 2016/17. It represents the fourth consecutive year that absence rates have risen.

It is compounded by a drop in the overall number of health visitors. Last year, the survey reported there were 8,440 health visitors in England, but in 2018 this fell to 7,852, a reduction of more than 2,500 since October 2015.

The survey responses also indicate that health visitors’ capacity to deliver all of the five mandated universal health and development reviews from the Healthy Child Programme in England has been seriously reduced, with some reviews given to untrained practitioners.

Dr Cheryll Adams, executive director of the iHV, said: ‘This is hugely worrying as many of the issues that health visitors are trained to assess during these contacts with families are hidden and are easily missed by less qualified practitioners.

‘This means that these issues may be much harder and more costly to address by the time that they become conspicuous.

‘It is about much more than the number of contacts, it’s the quality of those contacts that matters - having enough time to listen to family concerns and to act on them. It is clear there is now a significant postcode lottery of health visiting services across England. This is an unacceptable situation for English children as it has implications for their wellbeing across the life course.’

It comes as health visitors in Scotland received a boost this week, with the news that they will start on pay band 7 after the Scottish Government and unions agreed to alter the job description.