My hon. Friend may well be right. One of my constituents is a health visitor. According to her, the current status of health is not serving families well, based, as it is, on universally delivered process outcomes, which risk, to use a phrase she quoted to me, “ticking the box but missing the point”. That plays to the point my hon. Friend is making.
To illustrate the most successful ways of dealing with vulnerable families, I will use children’s centres as an example, although I will not get into a whole argument about them. The most successful ones that I have seen are those where hot-desking occurs between a district nurse, a health visitor, a social worker, a school nurse and others, who are all signposting. The health visitor may get over the threshold and say, “I am a bit worried that there is a mental health problem there. When I go back and see the community mental health nurse at the children’s centre, I might suggest she has a word.” That is the way it must happen. These are interlinking problems and it is not just down to one professional to treat them.
On the local authority, public health budgets have seen a significant reduction from 2015. The recent 1% increase for 2021 is welcome, but there is a long distance to go to replace some of the past reductions. Some areas have suffered disproportionately. I want to flag Suffolk, where, I gather, the council has been considering plans to slash the health visiting workforce by 25% to save £1 million. I think that is a false economy and short-sighted.
The decline in the number of health visitors since 2015 has been due to qualified nurses retiring or moving to other roles within the health service and too few trainees entering the profession. Alongside workforce cuts by local authority commissioners, the health visiting profession is also facing recruitment and retention problems, falling staff morale and poor progression opportunities. Health visitors have also raised safeguarding concerns as their caseloads increase to meet increasing need and cover shortages.
In a 2017 survey by the Institute of Health Visiting, health visitors reported that children are put at risk due to cuts in the workforce and growing caseloads, finding that 21% of health visitors are working with caseloads of over 500 children, as Karen Lee pointed out.