Health visitors facing caseloads of ‘up to 1,000’, MPs told

Health visitors are facing ‘unmanageable’ caseloads with services at risk of ‘falling off a cliff’ without immediate action to improve workforce numbers, an influential committee of MPs has heard.

The chief executive of the Institute for Health Visiting (iHV), Alison Morton, told the Health and Social Care Committee on Wednesday that health visitors in England are facing caseloads as high as 500, 750 and even 1,000 children each.

This contrasts with Scotland where health visitors have caseloads of ‘about 200’ and in Wales and Northern Ireland where there is a caseload of ‘about 250’ per health visitor, Ms Morton explained.

‘So, England is an outlier,’ she said.

‘This is going to keep falling off a cliff until somebody puts down a line and says that’s too many. Nobody can cope with that. It’s unrealistic.’

Ms Morton warned of ‘huge regional disparities’ in health visiting, with some areas ‘doing very well’ and others with families ‘who will never see a health visitor’.

Related Article: Lower gastrointestinal symptoms – supporting earlier diagnosis

In findings released in January, the iHV reported that only 45% of health visitors in England are able to provide continuity of care to families ‘all or most of the time’.

This is compared with 90% in Scotland, 86% in Northern Ireland and 85% in Wales.

A significant shortage in health visitors

Ms Morton said health visiting ‘needs extra special attention’ and warned that many services are being ‘decimated’ in England, with 5,000 current vacancies across the country.

‘We need to put our money where our mouth is and to fix this problem, because it’s having a huge impact,’ she added.

The iHV head described how cuts to the public health grant ‘directly correlates’ with cuts to health visiting posts, training and availability.

‘We’ve seen a reduction in health visiting training places. It’s been difficult for services to plan their funding because allocations are released very late,’ she continued.

Cuts to Level 7 apprenticeship funding

Last week the Department for Education announced the government’s plan to remove funding for Level 7 apprenticeships for people aged 22 and older.

Ms Morton echoed the concerns of other community nurse leaders, saying that the cuts would impact future health visitor training as demand for services continues to grow.

Also in its January findings, the iHV said demand for health visiting support is currently ‘far in excess’ of what local services are commissioned and able to provide.

Just under three-quarters (73%) of health visitors responding to the iHV’s survey said workforce shortages were impacting their ability to support families after a need had been identified.

Ms Morton described how the iHV had seen rising numbers of health visitors leaving the workforce, partly due to retirement, but also because of a lack of career progression.

Related Article: Action needed to tackle untreated hearing loss in care homes 

‘[Health visitors] are a precious resource, and we need to make health visiting an attractive career,’ she said.

‘We need reform, and we need support our services to bolster up and to address needs.’

The government spending review

Ms Morton said she hoped a commitment to improve health visiting will be part of the government’s highly anticipated 2025 spending review on departmental spending.

‘What they want is a government to stand up and say, “we back our health visitors, we support them, and we show you this by putting our words into action, and we’re going to invest in you”, so I’m hoping that might be the outcome of the spending review,’ she explained.

Recognising the ‘burn out’ many health visitors are facing, she also praised the tenacity of the workforce at an increasingly tough time for the profession.

‘I am overwhelmed every day by the tenacity of health visitors and the brilliant work they’re doing despite the pressures that they are under,’ she said.

Ms Morton’s frustration was shared by MPs, with committee member and Labour MP Ben Coleman describing the underfunding of early year’s health services as ‘an absolute disgrace’.

Related Article: ‘Alarming’ health inequalities between older people in the North and South of England

‘We have to put it right now. I understand the challenge that you are facing, and I really say well done again to you for the work that you’re doing to try and do the best for children and families in this impossible situation,’ he said.

The health and social care committee meeting marked the launch of a new inquiry into health and wellbeing during the first 1,000 days of life, from the period of conception to age two.

The Royal College of Nursing has demanded ‘urgent action’ to recruit, support and retain community nurses (including specialists like health visitors) as part of its submission to the government’s upcoming Spending Review.