Health Visitors (England)

Part of the debate – in Westminster Hall at 4:59 pm on 23rd October 2019.

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Photo of Luciana Berger Luciana Berger Liberal Democrat Spokesperson (Health and Social Care) 4:59 pm, 23rd October 2019

It is a pleasure to serve under your chairmanship this afternoon, Mr Bone. I congratulate Tim Loughton on securing this important debate and on his work with the all-party parliamentary group for conception to age two—the first 1,001 days.

I will start by paying tribute to the Institute of Health Visiting and, most importantly, to the army of health visitors themselves. I know what an important job they do from my own experience as a mum to a two-and-a-half-year-old and a seven-month-old. In particular, I put on record my thanks to Gill and Katie, who have helped me and my family. Health visitors do a brilliant job against a backdrop of falling numbers, growing case loads and, in some cases, unconscionable pressures. In the wake of the cuts to public health, it is now clear that we have seen a steady diminution in health visitors across England.

As we have heard, since October 2015, the number of health visitors in England has reduced by a quarter from just over 10,000 to just under 8,000, which piles extra pressure on existing health visitors. Nearly a third of health visitors have case loads of more than 500, which is twice the safe level set by the Institute of Health Visiting. Unfortunately, that can only have a detrimental impact on the quality of care. At best, it risks health visitors being less helpful. At worst, it is counterproductive to their aims and goals.

Looking at a number of indicators, there is mounting evidence that things are getting more challenging. The reductions in infant mortality have stalled. We have already heard about issues around breastfeeding, which is a subject that is particularly close to my heart. We now have some of the worst breastfeeding levels in Europe, and I say that as an MP in Liverpool, where so much work has gone on via our Babies and Mums Breastfeeding Information and Support—or BAMBIS—service to support and assist mums in their own homes. We have seen a great increase in the proportion of women breastfeeding in Liverpool, but levels countrywide are still far lower than they should be. We are facing an obesity crisis. Immunisation rates are falling. We have missed the target for measles and the UK has lost its measles-free status. We are living through a mental health crisis, and I reflect on the fact that the period of a woman’s life where she is 30 to 40 times more likely to experience a period of psychosis is the year after birth. That is the moment in her life where extra additional support is needed.

We see a particular challenge with adverse outcomes not being distributed evenly, which speaks to health inequalities. That issue falls far down the agenda and gets much less attention than it deserves, but we are seeing a widening of inequalities across the country. Poor health goes hand in hand with someone’s postcode, income, social status and what their parent or parents do for a living. The impact of inequality is keenly felt in too many areas, including in Liverpool and other disadvantaged neighbourhoods. Nearly 70% of health visitors have reported having to access emergency food aid and go to food banks on behalf of the families they are supporting. The Institute of Health Visiting stated in its report that those inequalities resulted in poorer physical and mental development, poorer academic achievement and poorer employment prospects at every stage of a child’s life.

We are talking about the most fundamental of issues: how can we ensure that every child born in this country has the best life outcomes and best life chances? Health visitors play such an important part in those outcomes and provide such a vital intervention in supporting new parents. The list of what they do goes on and on, and we have heard much about that already. They also play an important part in preventing ill health, rather than trying to cure it later. Health visitors play a critical role beyond health, whether that is supporting troubled families, improving early language development and learning at home, particularly where a child might have special educational needs, or improving parental confidence and knowledge to avoid unnecessary trips to our health service.

Health visitors should form part of a truly integrated system of health, care and wellbeing that is tailored to the parent and child, with the right interventions, advice and support at the right time. I reflect on that as a member of the Health and Social Care Committee. We did a report called “First 1000 days of life”, in which the first priority was for every child to receive the five mandatory visits. In fact, we said that that number should be increased to six, with a visit at three or three and a half years old to ensure that every child is ready for school. We perhaps do not like to talk about that issue, but we are seeing increasing concern about it from teachers across the country.

I am conscious that my time is coming to an end, so I want to reflect on that recommendation from the Health and Social Care Committee. Health visitors play such an important role. They support families where others do not have the opportunity to do so. They enter people’s homes and they are trusted. When I think about all the health professionals I connected with as a new parent, it was my health visitor who I relied on. We need to ensure that we are not creating the conditions for a public health crisis for future generations, and I hope that in the Minister’s response we will get some glimmers of hope that we will see an increase in the number of health visitors, not a further decrease.