A bleak picture for babies and young children

The NHS backlogs regularly hit the headlines, but they are only one part of the legacy left by the pandemic on the healthcare system – less high-profile backlogs of care in health visiting services have been overlooked within a “baby blind spot” in national policy which will leave equally serious challenges for both mental and physical health for babies, children and families across the UK, now and in years to come.

Children in England now have some of the worst health outcomes in Europe, late identification of unmet needs, and widening health inequalities. As a nation, we need to take this seriously.

UNICEF-UK has described health visitors as the “backbone of the early years… a safety net for all families”. They work with all families during pregnancy and the first five years of life to improve health and reduce health inequalities across numerous clinical pathways for adults and children, physical and mental health needs, child development and safeguarding.

Yet, despite health visitors’ best efforts, against a tsunami of need and a loss of almost 40 per cent of health visitors in England since 2015, too many babies and young children are missing out on health visiting support and the government’s promise of the “best start in life”.

The Institute of Health Visiting recently published the findings from the largest UK survey of frontline health visitors (n=1,323) who see first-hand the realities of family life across the UK which is largely hidden behind front doors and invisible to other services.

Accident and emergency attendances for children have increased by almost 60 per cent as parents cannot get the help they need elsewhere

Our survey findings paint a bleak picture of increased need across the population with poverty dwarfing all other concerns. Ninety one per cent of health visitors reported an increase in poverty affecting families over the last 12 months, with more families turning to foodbanks to feed their children.

In a recent interview, Sir Michael Marmot (who led a 2010 review into health inequalities) stated “stress associated with poverty will damage children’s brains, it will damage child development… the impact on health inequalities will be seen, not just in this generation, but in the children in the next generation, because children’s growth and development will be damaged by their parents’ struggle.”

This is not hypothetical – health visitors are seeing these impacts daily. More parents are experiencing mental health problems, domestic abuse and adversity which pose risks to the health and wellbeing of babies and young children; obesity and tooth decay are increasing, immunisation rates are falling, accident and emergency attendances for children have increased by almost 60 per cent as parents cannot get the help they need elsewhere, and a significant and growing minority of children are not reaching the expected level of development at two-and-two-and-a-half years.

As a result, a growing number of babies and young children with developmental problems, early signs of complex health conditions, or vulnerability are not being identified

Services are struggling to respond to the scale of need. Only 7 per cent of health visitors felt confident all families would be able to access the support they needed when a problem was identified – this was largely driven by a lack of health visitors (reported by 85 per cent) and not enough capacity in other services to pick up onward referrals (86 per cent).

Health visitors have responded with some excellent examples of innovation, but most areas are now struggling to deliver the Healthy Child Programme as intended. More than one in four children (28.5 per cent) in England did not receive their mandated two-to-two-and-a-half year developmental review in 2021-22; and national aggregate data masks wide local variations in service uptake and quality (range is 6.9 per cent to 98.8 per cent uptake between the lowest and highest performing local authorities and include virtual contacts).

As a result, a growing number of babies and young children with developmental problems, early signs of complex health conditions, or vulnerability are not being identified and are not getting the support that they need. This matters as we have more evidence than any other generation on the importance of the earliest years of life which lay the foundations for future health and wellbeing.

Early intervention can significantly improve outcomes. The consequences of delayed treatment are costly and can be life-limiting and life changing.

Growing numbers of child safeguarding cases are dominating much of health visitors’ work and they are concerned vulnerable babies are now being missed due to scaled-back services. Babies are our most vulnerable citizens, with the highest rates of death, serious incidents, and homicide compared to all other age groups of children.

National safeguarding data do not reflect the scale of the problem as metrics only capture the number of children on child protection, or child in need plans. With ever increasing thresholds for children’s social care, many vulnerable children now fall below this threshold which has knock-on consequences for health visitors who are expected to plug the gaps. This short-sighted fix will prove more costly in the long run as it shifts resources away from health visitors’ upstream prevention and early intervention work that is so crucial to our national ambition to reduce health inequalities.

Without urgent action, we risk undermining the life chances of so many. Along with many others, we are calling for a shift towards prevention and early intervention, and a cross-government strategy for the first 1,001 days that includes rebuilding the health visiting service in England. We cannot afford to ignore this crisis any longer. Rather than a cost, spending in this area needs to be prioritised by the Treasury and seen as the smartest of all investments in our nation’s future.

For the full survey report and references, see: Institute of Health Visiting (2023) State of Health Visiting, UK survey report: A vital safety net under pressure.