By Andy Ford, Chair Unite NW Health Committee
Numerous studies have confirmed that of all health spending, that spent on mothers and young children gives the greatest return. Maternity and Early Years care is one of the greatest examples of prevention before treatment. (For example, see this study)
Which is why it is so disappointing that since 2015 the number of health visitors has plunged from 11,000 to 6,500 – a drop of around 40%! Their budgets were shifted out of the NHS into local authorities and…guess what…cuts, cuts, cuts.
Health visitors are not only affected by the under-staffing caused by austerity; they also see first hand the devastation caused by austerity in working class communities – families being brought up in poverty; homes with no carpets, no beds, no blankets; women preyed on by abusive men; and children fed from food banks. Health visitors see the things that are normally hidden behind closed doors.
Each health visitor has a caseload that might include about 250 children; less in areas of deprivation. But because of all those cuts they routinely have to deal with 500, 600, or even more. More than 70% of health visitors surveyed recently said that staff shortages had affected their ability to help children.
But that is not just a problem for health visitors, young mothers or their children. The lack of prevention triggers all sorts of problems in the later health of children. These are problems that could have been dealt with early, nipped in the bud, and prevented.
Children regularly taken to A&E
Under two-year-olds are big users of A&E, along with the very old. [See ADULT SOCIAL CARE: too big to be ignored, too expensive to fix? – Left-Horizons]. Children are taken there at A&E with fevers, high temperatures, viral infections, rashes and breathing difficulties. Regular contact with a universal health visiting service could reassure worried parents, and could deal with the most common but least serious symptoms, and make evidence-based escalations.
Health visitors are key in vaccination campaigns, perhaps the most fundamental element of preventative medicine. And they are the first line of defence against child abuse.
Because it is a service open to everyone, there is no stigma attached to using it and on regular visits health visitors can look out for the hidden signs – maternal depression, coercion and control by partners, alcohol and drugs, or plain neglect and inability to cope. Enquiry after enquiry finds that the other statutory services often miss these signs because they are all looking at their own little bit.
Adverse Childhood Experience (ACE) is a known link to heart disease, diabetes, and mental illness in later life. Preventing, or even just reducing ACE, gives population health benefits for decades after.
And yet politicians like Wes Streeting prefer to announce new Health Hubs – even if funded by PFI-type schemes, or to invest in complex algorithms to triage A&E and patient discharge, whilst tolerating a hollowed-out health visiting service. It does not make sense.
Unite has a good membership amongst health visitors, but our reps often struggle for facility time in the face of under-funding and under-staffing. Sadly, there are whole Trusts with members and union recognition, but no reps. The union is even running a strike in Cwm Taff Morgannwyg, but strikes can only take us so far.
What is needed is sustained investment in the grass roots, the nurturing of new reps, and regularly bringing reps together to solve each other’s, and their own, problems.
Andy Ford is standing for the Unite NEC in the Health section. His election statement and other articles by him can be found on his website, here.
[Feature photograph is the cover of the booklet Why Health Vistors Matter, produced by the First 1001 Days Movement, here]
