Government must recruit 1,000 new health visitors, say MPs

At least 1,000 more health visitors must be recruited and mandated visits should be increased from five to six as capacity grows, a committee of influential MPs has told the government.

A new cross-party report from the Health and Social Care Committee says rebuilding the health visiting workforce, improving access to Family Hubs and reversing declining vaccination rates could significantly improve the lives of children in their earliest years.

The report focuses on the first 1,000 days of life – from conception to the age of two – which is a period widely recognised as crucial for brain development and long-term physical and mental health.

The government has been urged to recruit at least 1,000 additional health visitors and to use individual caseload sizes to determine how many more are needed every year.

Describing health visitors as ‘the backbone of early years care’, the MPs point to a dwindling workforce that has fallen by 43% since 2015, leaving a shortfall of 5,000 posts.

They also warned that those remaining in post are managing ‘dangerously high’ caseloads, including of up to 1,000 in some areas of England.

As part of its key asks of the government, MPs said that ‘safe staffing tools’ should be developed for the profession to ensure that health visitors have a manageable workload, and that a ‘specific plan to rebuild’ the health visitor workforce should be included in its forthcoming NHS workforce plan.

The committee also highlighted stark regional variation in the number of health visits families receive.

While some local authorities meet the target of ensuring every parent or carer receives five visits by the time a child is two-and-a-half, the poorest-performing council reached just 4% of families, the report said.

MPs called on ministers to set out clear steps to address this disparity and to also consider increasing the number of mandatory health visitor contacts in England from five to six. England currently lags behind the rest of the UK, with Scotland mandating 11 visits, Northern Ireland nine and Wales six.

As part of a broader push to improve child health, the report also calls for urgent action to reverse falling vaccination rates, with a target of reaching 95% coverage across England.

It recommends expanding pilot schemes that train health visitors to deliver vaccines in family homes, GP surgeries and Family Hubs, arguing that a larger workforce could help boost uptake.

Families left without support

Alison Morton, chief executive of the Institute of Health Visiting (iHV), said the report reflected what practitioners see every day.

She welcomed the committee’s ‘clear call for urgent action’ to rebuild a workforce that has been ‘severely depleted’ over many years.

‘This is something that the iHV has called for over many years as health visitors see the human face of years of cuts which have left too many families without the support they need.

‘We look forward to the government’s response and offer our ongoing support to turn its ambition to “give every child the best start in life” into reality,’ Ms Morton added.

‘A source of shame’

Committee chair and former district nurse Paulette Hamilton said the current state of child health in England should be ‘a source of shame’.

She warned that too many children are growing up at risk of obesity, asthma, tooth decay and ‘life-threatening yet preventable diseases’ because of missed vaccinations.

‘This committee now calls on the government to re-establish health visiting as a cornerstone of the state’s support for families in communities across England, offering help with perinatal mental health, advice on a range of issues on health and development and helping to get more children vaccinated against illnesses which should be all but non-existent in 21^st century Britain,’ Ms Hamilton said.

Royal College of Nursing (RCN) chief nursing officer, Lynn Woolsey, said: ‘Health visitors, school nurses and other vital staff in our communities are critical for giving babies, children and young people the best start in life.

‘Yet these specialist, safety-critical nurses have seen their workforce numbers collapse over the last decade.’

The upcoming workforce plan

Ms Woolsey warned that missed opportunities to improve child health are ‘putting even more pressure on already overwhelmed hospitals’.

She stressed that the government’s upcoming workforce plan, expected to be published in Spring, must include plans to invest in the child-health workforce.

‘The government’s ambitions to move to a prevention and community-first model of care are the right ones.

‘This report shows just how urgent action is needed and how important nursing will be to achieve this. The upcoming workforce plan must include clear funded targets to grow the health visiting and school nursing workforce and be supported by long term sustainable investment,’ she said.

Health visitors ‘not valued’ by NHS

Unite national officer for health, Richard Munn, said health visitors ‘are simply not valued’ by NHS Trusts and are ‘significantly underpaid’ for the work they do.

He repeated the unions calls for health visitors to be paid at Band 7, to match the range and complexity of their responsibilities.

‘Unite will be pressuring both government and the NHS to ensure that essential health visitor roles and properly paid to both attract and retain the staff needed,’ Mr Munn added.

Last January, a report from the iHV found that almost two-thirds of health visitors in England have warned workforce shortages are hampering their ability to support families in need.

A government spokesperson said: ‘This government is giving every child the best possible start in life – regardless of their background. We’ve put them at the heart of our 10 Year Health Plan with a range of preventative initiatives from obesity to dentistry, so we can help raise the healthiest generation of children.

‘This month we announced a new £2m pilot that will see health visitors reach families facing barriers to vaccines, to ensure even more children are protected. Parents are now also able to protect their children from chickenpox through the MMRV vaccine, which is for free for the first time ever.

‘We’re also backing our Best Start Family Hubs with an extra £500m, giving families access to joined up health and children’s services right in their own community.’