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The redeployment of health visitors to support the national coronavirus response has left remaining staff with increased workloads, worsened mental health and fears that the needs of children are being missed, a new survey has revealed.
In the wake of Covid-19, University College London (UCL) gathered the views of 663 health visitors in England to find out how the pandemic had affected their work.
“The most detrimental effects are felt by those who are already disadvantaged”
Dr Gabriella Conti
Overall, 60% of respondents reported that at least one member of their team had been redeployed between 19 March and 3 June. Of teams that had lost staff, 41% reported that between six and 50 colleagues had been moved elsewhere during that period.
Meanwhile, of teams that had lost a colleague through redeployment, 10% said that at least half of their staff had been moved and only 9% said they were given additional staff to fill the gaps.
Changes to health visiting teams during the pandemic meant remaining staff also had increased caseloads. In total, 253 respondents (38%) reported a rise in the number of children they were responsible for between 19 March and 3 June.
At the peak of the outbreak, face-to-face health visiting contacts had also been reduced. But among those who did undertake a home visit, 35% reported not having appropriate personal protective equipment (PPE).
The combination of increased caseloads and limited face-to-face contacts left “widespread concern” among health visitors that the needs of many children would be missed in the peak of the outbreak, found the survey.
The majority of health visitors were concerned about missed needs in relation to the child’s growth (83%) and development (79%), parental mental health conditions (92%) and breastfeeding (75%).
Of all respondents, 96% said they were concerned about children in homes at risk of domestic violence and abuse.
Study authors raised concerns about the “significant negative impacts” that increased workload and pressures had on staff wellbeing and mental health.
“A cross-government strategy is needed to reduce inequalities and ‘level-up’ our society”
In total, 67% of health visitor respondents said their stress levels at work had increased over the past year, and of those more than a third (36%) said if they could leave the profession, they would.
Dr Gabriella Conti, associate professor, UCL economics and institute of fiscal studies, who led the survey, said: “Whilst all families are impacted by Covid-19, the most detrimental effects are felt by those who are already disadvantaged – in particular, our most vulnerable infants and children whose needs are often hidden from sight.
“Increased caseloads for a significant proportion of health visitors, along with reports of a lack of PPE for home visits, has created a lot of additional stress and anxiety, during a time of great uncertainty and difficulty.”
Following the survey results, the researchers made a list of policy recommendations for health visiting services.
These included a clear workforce plan to “ensure that the health visiting service has sufficient surge capacity to manage the backlog of missed appointments, as well as demand for support due to the secondary impacts of the pandemic”.
In addition, researchers called for services which had been paused to be reinstated, with appropriate measures put in place such as the use of PPE.
They also wanted to see a “proactive plan” in place to ensure staff wellbeing during the restoration of services.
The use of virtual services should also be evaluated to “determine their effectiveness for identification of vulnerabilities and risks, impact on child and family outcomes and reducing inequalities to inform future digital change”.
“The redeployment of most health visitors was a mistake, unless they had a recent skill set for working in critical care”
Dr Cheryll Adams
Research assistant Abigail Dow, UCL economics, said: “A cross-government strategy is needed to reduce inequalities and ‘level-up’ our society.
“This will require investment to strengthen the health visiting service which plays a crucial role in the early identification and support of the most disadvantaged families.”
Dr Cheryll Adams, executive director at the Institute of Health Visiting said: “The redeployment of most health visitors was a mistake, unless they had a recent skill set for working in critical care.”
“Most were unfortunately redeployed away from their specialist work with vulnerable families into nursing support roles, even clerical roles.”
She added that the findings of the study had confirmed that “families have never needed the service as much as they have over the past few months”.
“It has been hard enough to reach vulnerable families during lockdown without having to do so from a caseload which may have doubled in size,” said Dr Adams.
It is now time for an “urgent workforce plan for this beleaguered profession”, she added, noting that the importance of the work of health visitors continued to be “misunderstood”.
“Robust delivery of the work of health visitors with all families is an essential way in which governments can ensure more positive outcomes not only for children and families, but also for society,” she said.
In response to the findings, a Department of Health and Social Care spokesperson said: “Two billion items of PPE have been delivered to NHS and social care staff across England with almost 28 billion items ordered to ensure continuous supply.
“We are determined to address the long-standing inequalities that exist in healthcare, be they in access, outcomes or people’s experience of their local health service.”
The survey, supported by the Institute of Health Visiting, was carried out between 19 June and 21 July using the online survey platform Qualtrics.
Data collection is still ongoing, and a full report will be released later this year, noted study authors.