Health Visitors (England)

Jonathan Reynolds Excerpts

Wednesday 23rd October 2019 Westminster Hall

[Tim Loughton]

The hon. Lady pre-empts a point I was going to make on page 5 of my notes, so I will take that bit out.

Unlike some other public service professionals, health visitors are non-stigmatising and usually welcomed over the threshold into homes, enabling them to give early advice and support to prevent later problems, encourage healthier choices, detect problems early and, in some cases, act as an early warning safeguarding alarm. Often when social workers are the ones to knock on the door, it may be too late, and that professional has a completely different sort of relationship with the family.

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

I am grateful to the hon. Gentleman for securing this timely debate. What he just said is so important. The mandatory health visitor contacts in my constituency are not taking place as they should. When constituents complain or I complain, we are essentially told that they are profiled based on risk, which is clearly not how a mandatory set of contacts should work. I worry that we sometimes make assumptions about socioeconomic status or other factors, whereas the kind of problems we are talking about can manifest themselves in any family. If we are serious about having a mandatory system, should it not be that, rather than discretionary? If it is about capacity, let us talk about that.

[Tim Loughton]

Again, the hon. Gentleman makes a good point, which was on page 5 of my notes. This issue affects everybody across society, often better-off, more affluent families who might be better at hiding it or less inclined to come forward to seek help. The charity that I chair has units in Liverpool, Newcastle, London and so on, and we see that middle-class parents who have serious attachment dysfunction problems with their children are less likely to come forward. Those, ironically, may be harder-to-reach people. Health visitors are the early warning system and are able to signpost some of those people to services. They can also point out, “I think you have a problem,” and it will be taken on trust.

I appreciate the good points that have been made, but I will make some progress. The cost of failing to intervene early is enormous—financially and, more importantly, socially. The impact of not intervening early can disadvantage a child through early years, school years, adolescence and often into adulthood. In some cases, it can be life-defining.

One of the great achievements of the coalition Government was to pledge a massive increase in health visitors. In opposition, the then shadow Health Minister, Andrew Lansley, championed the recruitment of no fewer than 4,300 new health visitors, based on the successful model of the Dutch Kraamzorg system—I was involved in research into that—where post-natal care is provided to a new mother and her baby an initial eight to 10 days immediately after birth.

Four years ago, the Government’s health visitor implementation plan and the “Call to action” scheme were the pride of the nation. The policy was built on sound evidence that the health visiting profession had the power to drive health improvements and provide a universal service designed to give every child that best possible start in life, as we all want to see. Impressively, for a Government target, it was achieved—just about—in the lifetime of the 2010 to 2015 Parliament.

Depressingly, since then, the numbers have started to drop dramatically. In June 2015, there were 10,042 full- time equivalent health visitors in England. A year later, that had fallen to 9,491 and the latest figures show a 31% drop from the peak. According to the Institute of Health Visiting,

“one in four health visitors do not have enough time to provide postnatal mental health assessment to families at six to eight weeks, as recommended by the government.”

In response to a survey that the institute put out,

“three quarters of respondents said they are unable to carry out government recommended maternal mental health checks three to four months after birth.”

That is a crucial stage at which to pick up mental health problems with the parents, which may already be impacting or will impact on the infant. It is not only about looking after the baby, but the family unit and particularly the prime carer.

To a large extent, the reason for that has been the transfer of responsibility for health visitors from the health service to local government, as part of its enhanced public health responsibilities. I am not challenging the wisdom of doing that, but it has come at the time of the greatest squeeze on local government spending recently. The architecture of the delivery of health and wellbeing services for babies and young children, I think, has been fragmented in a disorienting manner between local councils, Clinical Commissioning groups and NHS England, with insufficiently qualified scrutiny of how it works. There is an issue around the quality of informed local authority oversight over many of these public health roles.