– from the Institute for Health Visiting

By stewartb

Support for children and families in Scotland has been accorded high profile in news coverage in the past week, especially by BBC Scotland. Many, and notably here on TuS, have sought to counter the negativity which has prevailed, including in one instance ‘absolute’ negativity. So here are some further research findings from an independent  health institute which reinforce the positivity in this earlier TuS blog post: ‘Scotland has nearly three times as many health visitors per head of population’.

Source: Institute of Health Visiting (18 January, 2023) State of Health Visiting, UK survey report – a vital safety net under pressure. 9th iHV Annual Health Visiting Survey: data year ending November 2022.

About Scotland

Here some key messages from the IHV report (with my emphasis): ’WHO UNICEF-UK has described health visiting as the ‘backbone of the early years… a safety-net for all families’.  So health visiting is an important service!

The IHV notes: ‘There is some good news – the value of the health visiting profession has been recognised in Scotland and its government has invested £40 million to recruit and train an additional 500 FTE health visitors to deliver the Universal Health Visiting Pathway (UHVP) which offers 11 universal contacts to families.’

And it provides this research evidence: ‘A longitudinal study of the UHVP in Scotland reported positive outcomes, with:

• Increased coverage – the UHVP is being delivered by all Health Boards and is largely equitable across all socio- economic groups
• Additional reviews identified new concerns for children without previous concerns flagged (without the UHVP, these children with additional needs would have been missed)
• Parents reported a positive and trusting relationship with their health visitor
  • As a result, families were better able to ask for and accept the support on offer
• 89% of parents stated that they knew a great deal, or a fair amount, about the impact on children of parents’ smoking, drinking alcohol, or using drugs
• The service reached those that needed it most – parents living in the most deprived areas of Scotland were most likely to report having received a great deal or a fair amount of information from their health visitor
• Health visitors were described as “Approachable, non-judgmental, professional”.’

Comparative analysis

The IHV provides comparative analysis across the nations of the UK.

‘Only 37% of health visitors in England feel confident that they are providing a ‘good’ or ‘outstanding service’ that can adequately safeguard children.

This contrasts with:

60% in Scotland

53% in Wales

57% in Northern Ireland’

‘In England only 6% of health visitors work with the recommended average ratio of 250 children per health visitor: 28% have more than 750 children

This contrasts with:

Scotland: 69% have less than 250 children: only 1% report 750 or more’

‘Only 3% of health visitors in England provide all families with continuity of health visitor. This contrasts with:

88% of health visitors in Scotland are able to provide continuity of health visitor to all families

80% in Wales

87% in Northern Ireland.’

The report includes these two telling charts: the favourable findings for health visiting services in Scotland are marked. I draw your attention to the comparison with Wales where there has been, of course a very long period of the Labour Party in government.

The IHV’s observations on health visiting in England

‘Health visitors in England also raised serious concerns that national data mask increases in child safeguarding, as:

• Children living with significant risk and vulnerability are not detected as services are cut
• Social workers’ caseloads are capped to a maximum – growing numbers of children living with significant risk and vulnerability now fall below higher thresholds.’
  
  

‘Health visitors in England reported concerns that child protection or child safeguarding cases are not being detected due to practitioners’ reduced contact with families and cuts to the number of health visitors – babies and young children who are distressed or at risk of significant harm are particularly vulnerable as they are largely invisible to other services without a robust health visiting service to identify them.’

‘Social workers’ caseloads are capped to a maximum number of children which masks rising levels of need. Health visitors are reporting that the thresholds for children’s social care are now much higher. Rather than falling levels of need, children living with significant vulnerability and risk now fall below this higher threshold, whereas in previous years they would have been supported by children’s social care.’

‘We also need to be concerned that more than 1 in 4 children (28.5%) in England did not receive their 2-21⁄2 year developmental review in 2021/22 and their needs are currently unknown. In addition, there are concerns about data quality as some children who did receive the review had it completed over the phone which is much less accurate at identifying need than a face-to-face contact.’

‘Our survey findings clearly show that England is now an outlier in terms of health visiting practice, with a considerably lower percentage of all universal health visiting contacts being completed by a qualified health visitor when compared with the other UK nations’  (see Table 5 above)

‘An economic report published in June 2021, estimated a shortfall of 5,000 health visitors in England. Since this calculation, the profession has sustained a further reduction of 912 full time equivalent (FTE) health visitors across both NHS and non-NHS providers representing a loss of almost 40% of health visitors in England since 2015.

And finally: ‘Without wanting to scaremonger, it only requires simple maths to calculate that the health visiting profession in England will cease to exist in 15 years if the current rate of workforce loss is not addressed. This cannot be ignored any longer as the inevitable knock-on impacts are already being felt across the health and care system, the costs of late intervention are soaring, and the recent Inquiry into the murders of Arthur Labinjo-Hughes and Star Hobson recognised …’

Now imagine if the report had reported the above for Scotland! Excitement in the BBC Scotland newsroom?