The vast majority of health visitors surveyed (96 per cent) reported being concerned about children in homes at risk of domestic violence and abuse. They were also worried about:
- missed needs in relation to the child’s growth (83 per cent) and development (79 per cent)
- parental mental health conditions (92 per cent)
- breastfeeding (75 per cent).
The survey of 663 health visitors in England found that 41 per cent of respondents in teams that lost staff had between six and 50 team members redeployed between 19 March to 3 June this year. In approximately a tenth of these teams there was a redeployment of at least half the staff members.
This meant that 253 respondents (38 per cent) had their caseload increase, some with an increase of 50 per cent or more, and 73 per cent of those that experienced a change reported that their caseload had not returned to its usual size.
Dr Gabriella Conti, associate professor at UCL Economics and Institute of Fiscal Studies who led the survey, said, ‘Whilst all families are impacted by Covid-19, the most detrimental effects are felt by those who are already disadvantaged - in particular, our most vulnerable infants and children whose needs are often hidden from sight.
‘Increased caseloads for a significant proportion of health visitors, along with reports of a lack of PPE for home visits, has created a lot of additional stress and anxiety, during a time of great uncertainty and difficulty.’
More than a third (35 per cent) of health visitors who conducted face-to-face visits reported that they had done so without appropriate personal protective equipment (PPE), such as masks, aprons and hand gel.
The increased workload and pressures have had significant negative impacts on staff well-being and mental health, with 67 per cent reporting that their stress levels had increased in the past year.
The researchers suggest a number of policy recommendations, including:
- Health visiting services to be reinstated (where not already happening) to provide vital support and a safety-net for children, with appropriate measures put in place to reduce the spread of the virus.
- An evaluation of the use of virtual, non face-to-face service delivery methods to determine their effectiveness for identification of vulnerabilities and risks.
- A clear workforce plan to ensure that the health visiting service has sufficient capacity to manage the backlog of missed appointments, as well as demand for support due to the secondary impacts of the pandemic.
- A proactive plan to ensure staff wellbeing during the restoration of services.
Professor Russell Viner from the Royal College of Paediatrics and Child Health said that the findings paint an ‘extremely bleak picture’ and that the redeployment of health visitors away from children and families should not be allowed to happen again. He urges that children be kept at the ‘heart of planning’ in the event of further local or national lockdowns.
‘The health visitor workforce is absolutely vital to the health of children and now more so than ever. Health visitors act as a frontline defence against multiple child health problems – from providing advice to parents on nutrition and feeding, to early identification of risk factors for mortality, advising on vaccinations or identifying vulnerable children,’ he said.
‘As under-resourced services struggle to cope with the backlog of missed appointments, missed reviews, missed operations and missed vaccinations, UK children are facing a winter from which some will never fully recover. Their needs must be prioritised by this Government right now. Proper resourcing of a profession as key as health visiting is a very good place to start.’
Alana Ryan, senior policy and public affairs officer at the NSPCC, said, 'Before the pandemic hit, successive cuts to public health funding and a significant decline in NHS health visitors put huge pressure on those still in the profession. This, coupled with the impact of COVID-19 has meant the strain has been felt by families who have missed out on the consistent care necessary for giving babies the best start in life.
'Research by the NSPCC carried out even before lockdown showed that a quarter of new mothers saw a different professional at every check-up, leaving many unable to share concerns about their mental health.
'As we emerge from this pandemic, it more important than ever that we reset our priorities and ensure the Healthy Child Programme is sufficiently resourced. This will enable all mums and babies, wherever they call home, to receive vital care during this critical period.'
