Public health budget cuts have decimated health visiting services

Author: Caroline White

Cuts to public health budgets have decimated health visiting services, leaving many no longer able to offer the minimum level of support and carry out basic checks, finds the latest annual survey* of health visitors in England, published by the Institute of Health Visiting.

Services lost around one in five health visitors between 2015 and 2019 – the full-time equivalent of 18% of the workforce ─ after health visiting commissioning transferred from the NHS to local authorities in 2015.

Between 2015-16 and 2019-20 councils saw a £700 million real terms reduction to their public health budgets.

Nearly half (48%) of those responding to the survey said they feel so stretched that they fear for children’s safety. This is more than double the proportion who reported this in 2015 (23%). Only around one in five (21%) rated the quality of care that they can now offer families as ‘good’ or ‘excellent’.

Almost a third of health visitors said they are now responsible for between 500 and over 1000 children: the Institute considers the maximum caseload should be 250 ─  less in areas of high vulnerability.

Dr Cheryll Adams, executive director of the Institute of Health Visiting, said: “It is absolutely unacceptable that many families are struggling through the significant demands of early childhood without the vital support that they need and are entitled to through the government’s flagship Healthy Child Programme.

“Indeed, the government’s pledge to give every child the best start in life has been left in tatters after year-on-year cuts to the public health grant, which have dismantled the health visiting services designed to support them in many areas.”

The Institute is calling for: new ring-fenced cross-government funding for early intervention and the health visiting profession; statutory protection for the health visitor role in the delivery of the Healthy Child Programme and for health visiting to be returned to statutory regulation.

A new workforce strategy for health visiting is also needed, with a new focus on improving the quality of services which health visitors can offer families, it says.

Dr Adams continued: “Our survey indicates that health visitors have seen rising demand for support from families, almost certainly related to austerity. Meanwhile, they themselves have battled with ever increasing caseloads, due to the fall in health visitor numbers.”

She added that “it was particularly disturbing that one in four health visitors told us that they are seeking professional help from a GP or elsewhere, due to the demands of their job.”

Councillor Ian Hudspeth, chairman of the Local Government Association’s Community Wellbeing Board, commented: “We now face a serious shortfall in the number of health visitors, which has to be filled if we are to continue to meet the needs of families in our local communities.

“The government announcement of a real-terms increase in public health funding this year is positive, but this report reinforces our call for long-term sustainable funding for vital council services, including for children’s public health and prevention.”

She continued: “Every pound invested by government in council-run services such as public health helps to relieve pressure on other services like the NHS. There cannot be a sustainable NHS without a sustainable public health system.

“Since councils took over responsibility for the public health of those aged 0-5 in 2015, they have done everything they can to provide this vital service, but years of funding reductions mean public health services are struggling to keep pace with the scale of demand.”

Sean O'Sullivan, head of health and social policy at the Royal College of Midwives, said the importance of good health and support in the first years of life couldn’t be understated.

“Yet we see two key groups of health professionals working in this area, midwives and health visitors, facing serious shortages. Their work is also hampered by significant cuts to public health budgets,” he said.

“This is a recipe for poorer, not better health for the child and the adults they will become,” he added. “Shortages can also fragment care when we need to see seamless care between these vital NHS staff. We need to see the government invest in early years and invest in the staff that support and promote good child health." 

*State of Health Visiting in England. Institute of Health Visiting, February 2020.