Health Visitors (England)

Part of the debate – in Westminster Hall at 5:13 pm on 23rd October 2019.

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Photo of Julie Cooper Julie Cooper Shadow Minister (Health and Social Care) (Community Health) 5:13 pm, 23rd October 2019

It is a pleasure to serve with you in the Chair, Mr Bone. I thank Tim Loughton for bringing this important subject before us, and for the sterling work that he does chairing the all-party parliamentary group for conception to age two—the first 1001 days.

We have had some really interesting speeches, and I thank all Members who have spoken for some very convincing contributions that have outlined very clearly the massive contribution that health visitors make to communities and to individual families, covering all sorts of services—from basics such as the transition to parenthood, particularly helping new parents, to support with breastfeeding and weaning, and encouraging the full take-up of immunisations. It has been pointed out that we have a very poor record on that. Health visitors also support the mental health of parents who might be feeling vulnerable in their new role; advise on a host of minor ailments from which children might suffer; ensure readiness for school; check that developmental changes are happening at the appropriate stage; and help to pick up early any special needs and problems.

The hon. Member for East Worthing and Shoreham talked about the importance of safeguarding and the cost—not just the cost to the family, but the financial cost of services when it does not happen. Health visitors, as registered nurses with additional midwifery, community and public expertise, play a tremendous role. I not think that there is any disagreement in the Chamber about the contribution that they make. Praise for them among health professionals is widespread. The president of the Royal College of Paediatrics and Child Health has said:

“Health visitors act as a frontline defence against multiple child health problems”.

The Children’s Commissioner for England said:

“Health visitors are an essential part of the country's support structure for young children and their parents”.

My daughter Anna became a new parent six months ago today. Ahead of the debate, I asked her what she thought of her health visitor. She said:

“We loved our HV. We didn’t have consistent midwifery care—a different midwife every week before and after Nora was born—but we had one HV who first visited me before Nora was born and told me she would be my health visitor throughout the early stages of me becoming a mum. We found her especially helpful when Nora started struggling” with feeding. Anna also said of her health visitor that

“we’d been discharged by the midwife and didn’t want to bother the GP. She was just a phone call away or would pop to see us.”

I am grateful to Luciana Berger for what she said about the benefit she had from health visitors. There is no disagreement about their value, and I put on the record my thanks to health visitors across the country for the sterling work that they do in times of considerable difficulty and challenge. They are very much a British phenomenon. We are the envy of the world, having health visitors—and with good reason. We all know that there is nothing more important than giving children the best possible start in life.

Bearing all that in mind, it is distressing to hear that the number of health visitors is falling so drastically. We are going backwards and it is extremely worrying. The Minister may point to the fact that David Cameron increased the number of health visitors, but that is old news, and the picture now is very different. In 2015, there were 10,300 health visitors; by 2017, that number had fallen to 8,244. The reality is that every month the numbers fall. None of that is really surprising considering that, in late 2015, public health and the commissioning of health visitors became the responsibility of local authorities. That transfer of responsibility was accompanied by a budget reduction of 6.2% and the requirement to cut year on year until 2020. Funding for health visitors is not ring-fenced, so is it any wonder that cash strapped authorities are commissioning fewer and fewer?

I raised my concerns about this last year with the former Health Minister, Jackie Doyle-Price. She said:

“health visitors are probably the most important army in the war against health inequalities. They provide an intervention that is very family-based and not intimidating…There has been a decline…which we really must address if we are to get the earliest possible intervention and the best health outcomes for children.”—[Official Report, 23 July 2019;
Vol. 663, c. 1204.]

I totally agree. That was said last year, and the Government have failed to act and the numbers have continued to fall.

The numbers of children have not fallen, though, and it is therefore important to recognise the increased workload of the remaining health visitors. My hon. Friends the Members for Heywood and Middleton (Liz McInnes), for York Central (Rachael Maskell) and for Lincoln (Karen Lee) all raised the falling numbers, and pointed to the fact that the Institute of Health Visiting current case load identification exceeds safe levels. The recommended maximum case load for health visitors is 250. The Care Quality Commission reports that the average is 500 and, in the London Borough of Hounslow, the average number—not the highest—is 829 per health visitor. That is obviously affecting their ability to deliver a quality service, and it is now true that the proportion of six-to-eight-week reviews completed for newborn children ranges from 90% in some areas to only 10% in others. It seems that vital workforce planning is a thing of the past, and our children and communities are paying the price.

In the widest sense, that approach is so short-sighted. No health professional is better placed than a health visitor to support parents and children in those vital early years. The early intervention of a well-qualified, accessible health professional can be the difference between children thriving and not. For every child who does not thrive, there is a cost, not just to the family but to wider society. There is a wealth of evidence to demonstrate the high impact that health visitors have in key areas.