The decline in social workers has been accompanied by a slump in the numbers of health visitors – staff who play a vital role in the chain of child protection…
Where have all the health visitors gone?
WORKERS, APRIL 2009 ISSUE
The death of ‘Baby P’ in the London Borough of Haringey showed the inadequacy of various public bodies. Of course responsibility lay with the baby’s mother, her partner and another man who were convicted of involvement in his death, but there are many other failings and inconsistencies which have been highlighted.
Some of these have taken the form of scapegoating social workers, and unions such as Unison have been called on to ensure that workers who were not at fault should not be blamed. One of the effects of the shrieking tabloid publicity on the case has been to produce a well documented collapse in the number of workers prepared to train to become social workers.
Another and less publicised dark side of Baby P’s case is the poor state of health visiting.
Survey
Two months before the case came to public attention in November 2008 the union Unite and the Community Practitioners and Health Visitors Association (CPHVA) published a survey of health visitors in England. The survey found that case loads of more than 500 children per health visitor were commonplace for 40 per cent of health visitors and that one quarter of health visitors feared that “another Victoria Climbié” – the other high-profile child death in Haringey – could happen in their primary care trust (PCT)
If this is bad (and the government has accepted that there were shortages), then the situation has apparently become even worse. These 500 children per health visitor caseload is now seen as low in some areas, according to the UK Public Health Association.
Emergency cover
The Association’s chief executive recently said, “There are many places especially in London and the South East with 800 to 1,200 pre-school children to one health visitor.” She also said that a shortage of health visitors was forcing some PCTs to implement what she called ‘“emergency cover”.
This includes Saturday clinics to which new mothers are being invited because there are too few health visitors for home visits, and in some places staff nurses are being substituted for health visitors to carry out new baby visits. “Unseen children and families are always at the highest risk; there is no way of predicting what would be found when they are visited, which is why this form of substitution is not safe practice,” she added.
Decline in health visitors since 1997
East of England
11 per cent
South West
9 per cent
Yorks and Humber
8 per cent
North West
8 per cent
North East
7 per cent
London
6 per cent
South Central
6 per cent
East Midlands
4 per cent
South East coast
1 per cent
In February 2009 there were 131 health visitor vacancies on the NHS Jobs website, 25 of them within 20 miles of London, an area which is particularly struggling with heavy caseloads.
Since 1997 the number of health visitors has steadily declined. In the 10 years between 1997 and 2007 numbers dropped from 12,410 to 11,569, which was lower than the original 1997 figure. The number of whole time equivalent health visitors is even lower. In 1997 the figures were at 10,025. By 2007 this had dropped to 9,056. According to Unite and the CPHVA this represents a health visiting job lost every 27 hours in that ten-year period.
A recent review in the Nursing Times revealed that health visitors in the London Borough of Redbridge had the heaviest caseloads. On average, each health visitor had a load of more than 1000 children under five, more then ten times the number in Doncaster. Many London boroughs have health visitors with caseloads over 600 (Enfield, Sutton and Merton) and others (Hackney, Camden and Newham) have far more than 500. Outside London, Warwickshire in general, and Coventry in particular, also appear in the top ten caseloads with 720 and 597 per health visitor respectively.
The situation could be considerably worse as many PCTS have not responded to the Unite/CPHVA survey. What can be determined from the figures that are available is that – with the odd exception of the West Midlands (odd in the light of the decline mentioned above in Warwickshire and Coventry) – there is universal depression of numbers (see Box).
There is a growing view among health visitors, and indeed other health professionals, that this important service should be expanding and not contracting.
The birth rate in Britain is rising as is the number of children with difficulties and special needs. Instead of attacking social workers whenever there is a case of child mistreatment, we should invest in the training of future skilled health visiting nursing staff.
In spite of the efforts of health workers, these figures damn Labour’s stewardship of health visiting as a profession and should be a warning to those complacent enough to think that a vote for Labour will secure health care in the future.