Health visitors in England should be mandated to offer eight contacts with families in order to develop trusting relationships, a new report has concluded.
The report, published by the Institute of Health Visiting (iHV) last week, suggested that on top of the five contacts currently required with families, three more mandatory contacts should be introduced alongside additional tailored support where needed.
The document, called ‘Health Visiting in England: A Vision for the Future’, also urged the Government to return investment in the service to 2015 levels with figures showing a 31.8% reduction of health visitors from 10,309 to 7,026 since then.
The iHV’s new vision for health visiting is a service that moves away from an emphasis on outcomes to approach that ‘measures impact over time drives quality improvement and supports integrated working.’
It warned that health visitor contacts with families are not ‘end points in themselves’ as the current requirements have come ‘at the expense of personalised support for families with identified needs, or with any regard for quality’.
It explained: ‘The recommendation for eight universal contacts should focus on improving “outcomes” rather than risk perpetuating the existing culture of equating success with delivering X number of contacts.’
The three additional contacts should come at three to five weeks, three to four months and three to five years to support school readiness, the report suggested. Currently, the final mandated health visit comes at two years.
Health visitors would need ‘flexibility and professional judgement’ to apply the new universal contacts, the report said: for example, a mother who is confident with introducing solid food and has no signs of perinatal mental health problems may not decide to take up the three to four-month review.
The document also sets out 15 ‘high impact areas’ where health visitors can make the greatest difference to infant, children and families’ outcomes – such as sleep, healthy couple relationships and breastfeeding. Currently, there are only six.
It argues that the Healthy Child Programme – which the Department of Health and Social Care is planning to update, and is a universal prevention, health promotion and early intervention programme for families – must be fully supported by the Government, which should include strengthening the workforce.
The report suggests a maximum caseload of 250 children for health visitors – when health visitors in some areas are responsible for over 750 children – increasing the full-time workforce to 12,000; and for workforce modelling to be included in the planned review of the Healthy Child Programme.
Earlier this year, the National Society for the Prevention of Cruelty to Children warned that around one in four families in England are not receiving mandated health visits when their baby turns one because of a decline in the number of health visitors.
Dr Cheryll Adams CBE, executive director of the iHV, said: ‘Despite overall improvements in child health, England lags behind other countries on many key health outcomes: infant mortality reductions have stalled, our breastfeeding and obesity rates are amongst the worst in Europe, our immunisation rates are falling and health inequalities are seen across all indicators.
‘The current status of health visiting is not serving families well, based as it is on universally delivered process outcomes which risk “ticking the box, but missing the point”. There remains a persistent gap between what the evidence tells us, and the profession aspires to achieve, and what is currently able to be funded and provided since the year on year cuts to public health budgets starting in 2015.
‘Based on the evidence, we recommend that the universal offer in England includes three additional service “review points”, increasing the offer to eight contacts, with additional tailored support where needed, aligned primarily to fifteen High Impact Areas where health visitors can make the greatest difference to infant, children and family outcomes.
‘But also recognising the value of health visiting in, for example, supporting the mother postnatally to manage ongoing physical consequences of giving birth, supporting the family of a child who has a chronic and worrying health issue such as asthma, supporting families through a bereavement or working with a people within marginalised groups.’
A Department of Health and Social Care spokesperson said: ‘We know what happens in childhood can have an impact well into later life and health visitors play an important role in supporting families.
‘We are working to modernise the Healthy Child Programme so they can reach more children and provide personalised support to their families.’