Health visitor postcode lottery continues

Family and Parenting Institute

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How often a child sees a health visitor is still a postcode lottery, according to new research which reveals the ratio of health visitors to children under five in England.

Figures released today (Friday May 1, 2009) by the Family and Parenting Institute show that there are huge variations in the number of health visitors up and down the country - County Durham PCT has one health visitor for every 165 children whereas some London PCTs have as few as one health visitor for 800 children.

The findings come ahead of the Department of Health and the CPHVA/Unite's summit on health visitors taking place on 5 May. This follows Lord Laming's recommendation that the number of health visitors needs to be increased*.

Mary MacLeod, Chief Executive of the Family and Parenting Institute said: "The value of health visitors is unquestionable. Parents tell us they are a lifeline. Having a baby is a great joy but also a huge change for any family, especially first time round as you deal with sleepless nights and new demands, Mums and Dads are eager for good advice. And a well-trained health visitor can make all the difference

"Health visitors respond to parents' worries and concerns, and their unique relationship and position of visiting families in their home means that they can detect problems that parents may not talk about – such as post natal depression, domestic violence or child abuse. They really are the frontline, able to pick problems early before matters get out of hand. This postcode lottery is unacceptable. We need a universal health visitor service so that all parents can have the support they want and need and children's wellbeing can be safeguarded."
The Family and Parenting Institute has been campaigning for more health visitors since 2007. It is calling for:

• a universal health visitor service with an intensive service for parents who will benefit most;
• a preventative health visitors service – the key to unlocking support for vulnerable families who are still missing out;
• and a well-trained health visitor service with a clearly defined role and a better career structure.

The health visitor table shows a clear North-South divide in the health visiting service. The top three performing PCTs, when it comes to health visitors, in England were County Durham, Darlington and Bournemouth. Of the ten PCTs with the lowest number of health visitors, eight of them were in London.

There was also disparity in PCTs' budgets for health visiting. The biggest spender, Wirral PCT allocated over £386 per child under five (in the financial year 08/09). South West Essex Teaching PCT has much shorter pockets for its health visiting budget spending just over £60 per child. That's a difference of over £320 between the two PCTs.

CPHVA/Unite which represents health visitors recommends that health visitors should have a case load of no more than 250 children – only 15 of the 136 respondents meet this target.

The Family and Parenting Institute has also compared the number of health visitors each PCT had in 2006 with how many they have now. The findings show that some PCTs (including some who had the lowest number of health visitors in our last survey), have dramatically increased numbers, while in other Trusts numbers have dropped significantly over the last two years.

Lambeth's health visitors caseload has nearly doubled (88% increase). At the other end of the spectrum Darlington has gone from having 17 health visitors to 29 for 5,300 children.
Karen Reay, Unite National Officer for Health said: "The latest research from the Family and Parenting Institute backs up the feedback we receive from our members of increasing workloads and an over-stretched health visitor workforce.

"The FPI findings reinforce Unite/Community Practitioners' and Health Visitors' Association's long-standing demands that an extra 4,000 health visitors are employed and that training budgets for the next generation of health visitors are immediately restored.

"We look to the Department of Health 'summit' on health visiting on 5 May to formulate a practical programme of action over the next two years to address the crisis in the profession."
In 2006 the Family and Parenting Institute spoke to parents about the health visiting service. The survey found that parents love and need health visitors – but for some they did not see their health visitor as much as they would like.

There were tales of parents travelling to visit relatives who had children when their health visitor was coming round – just so their own children could be checked out too.
Added Mary: "Those PCTs that do not have adequate number of health visitors run the risk of not spotting serious problems such as postnatal depression, domestic violence and child abuse.
"Parents need a commitment from the Government and health authorities that their baby's health and wellbeing is a top priority. Employing well trained health visitors with manageable case loads is the way to go about it."

- ENDS -

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• Lord Laming's report http://www.dcsf.gov.uk/pns/DisplayPN.cgi?pn_id=2009_0053

For more information
Please contact the Family and Parenting Institute press office on 020 7424 3477. If calling out of hours please contact Emma Brennan on 078139 51418 or Sally Gimson on 078904 03338.

Case studies available on request.

Notes to editors
The Family and Parenting Institute researches what matters to families and parents. We use our knowledge to influence policymakers and foster public debate. We develop ideas to improve the services families use and the environment in which children grow up.

The figures are based on the number of whole time equivalent health visitors employed in December 2008.  A freedom of information request was sent to every PCT in the country: out of the 152 PCTs, 138 responded with data on the number of health visitors, 134 responded with data on budget.

The questions we asked:

• How many whole time equivalent (WTE) health visitors who work with children under five did you employ in your PCT in December 2008?
• How many children under five did you have living in your PCT in December 2008?
• How much was allocated in your PCT's 2008/09 budget for health visiting?

We have been campaigning for more health visitors since 2007. www.familyandparenting.org/healthVisitors

 

Fact file
(facts from the Family and Parenting Institute unless otherwise stated)

• There is a total of 7863.78 whole time equivalent health visitors across the 138 PCTs that responded to our survey.
• 88% of PCTs do not have enough health visitors (when measured against CPHVA recommendations).
• The five worst PCTs for health visitor numbers are all in London.
• Two in five health visitors were over 50 years old, with almost one per cent working beyond age 65 (Department of Health, 2007).
• In 2004, the overall birth rates for women of all ages were highest in London (source: ONS).
• According to Unite, the number of NHS health visitors is currently at a 14-year low (source: Unite/CPHVA).
• 76% of parents want advice from a "trained health visitor with up to date knowledge".
• 46% of parents (57% of mothers, 27% of fathers) felt sad, unhappy or despondent following their child's birth.
• Around 1 in every 10 women has post natal depression after having a baby (source: Royal College of Psychiatrists).
• It is estimated that 30% of domestic violence incidents begin during pregnancy (source: Refuge).