Warning over budget cuts as health visitor numbers plummet

The number of children’s health visitors has fallen from 10,000 in 2015, when councils took on the responsibility for commissioning health visitors, to 8,000 – excluding those working outside the NHS.

“The funding has simply not kept pace with the scale and demand”

Ian Hudspeth

The LGA said the levels of children’s health visitors retiring and taking other NHS jobs combined with too few trainees entering the profession has led to the workforce being “stretched to its limits” at a time when the number of vulnerable children and families is rising.

The closure of the coalition government’s Health Visitor Implementation Plan in 2015 led to an immediate fall in new training places of 22%, The LGA said. Councils’ public health budgets have also reduced by £531m between 2015-16 and 2019-20.

Prior to that point, the implementation plan, which ran from 2011 to May 2015, had expanded the workforce nationally by almost an extra 4,200 people across England.

The LGA warning follows the publication last month of the Commons’ health select committee report on the first 1,000 days of life, which the LGA said recognised the crucial support provided by councils and the significant financial constraints they were under.

All families with young children should get an extra health visitor check at age three, according to the influential group of MPs which called for a major refresh of public health services for under fives.

Meanwhile, in survey findings published at the end of last year, health visitors themselves voiced fears of child tragedy as a result of increasing caseloads and high levels of stress.

The Institute of Health Visiting survey found that many reported rising caseloads, high levels of stress and were worried they would not be able to help children in need due to stretched services.

Ian Hudspeth, chair of the LGA’s community wellbeing board, said children’s health visitors working in local government play a “pivotal” role in ensuring all children get “the best possible start in life”.

“Health visitors have increased the number of contacts they make with children and families, including offering vital support via schools, nurseries and children’s services, which has led to better outcomes such as an increase in school readiness,” he said.

“However, the funding has simply not kept pace with the scale and demand and we now face a serious shortfall in the number of health visitors, which has to be filled if we are to continue to meet the needs of families in each of our communities,” he added.

The LGA said it was now calling on the government to reverse these public health reductions in the upcoming spending review to ensure that enough support is given to those aged 0-5.

But the new NHS long-term plan has indicated that some if not all responsibility for commissioning key public health services including health visiting, school nursing and sexual health could revert to the NHS.

In a move welcomed by public health nursing organisations, the government pledged in the NHS Long Term Plan in January to look again at commissioning arrangements which critics claim are simply “not working” at the moment.

Public health services including health visiting, school nursing, and sexual health are currently commissioned and funded by councils after responsibility transferred from the NHS to local authorities, triggered by the Health and Social Care Act 2012.

Local authorities gained control over budgets for public health services, including school nursing for five to 19 year olds, in April 2013. They then took over the responsibility from the NHS for commissioning for services for all 0 to 19 year-olds, including health visitors, in October 2015.