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Do not repeat the unfortunate natural experiment of cutting health visitors

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The commissioning transfer for 0-5 years services from the NHS to local government is an exciting opportunity for health visiting to return to its public health roots with local authoritiesembracing new potential for integrated services.

We recognise that local government, and directors of children’s services are feeling the full pressures of public spending reductions.  In turn, we want them to recognise that our service is not a luxury but an absolutely core component of public health that they and their population cannot afford to lose.

Health visitors work upstream where they provide many services, preventing formal child protection interventions for many children and thereby, contributing towards reducing budget pressures. The country is still facing the consequences of significant cuts to health visitor numbers between 2000 and 2010, with an increase in inappropriate skill mix. 

The impact from those cuts has been felt by a generation of babies born at that time whose families received little support from the service – we heard stories of children arriving at school in nappies, unable to speak clearly or with unidentified educational needs.  No commissioner would want to repeat that legacy. The massive shortages have only just been overturned by the huge investment in training more health visitors by the last government.  Local authorities tempted to see the arrival of health visiting budgets as a saviour against the spending cuts they face, need to learn from this recent history and not repeat the mistakes made by NHS commissioners.

Health visitors are a highly skilled workforce, whose outcomes are directly related to their ability to form a relationship with each and every family they are responsible for. The best place for doing this is in the home, which also allows for a full holistic assessment for any health risks as well as immediate family health needs. 

As the majority of need is hidden, so targeted services only have an impact on a small proportion of the need we must tackle to improve the public’s health.  Postnatal depression, domestic abuse and substance misuse are not respecters of social boundaries and can remain hidden damaging huge numbers of children with the mental health consequences often not identified until those children reach school age.

We have increasing evidence to show that health visitors can reduce inappropriate use of GP and hospital services by families, late identification of children with special needs and language delays or children not school ready, as well as targeting obesity and the child mental illness epidemic currently being faced. 

We still need more research, but the unfortunate natural experiment that occurred when the service was drastically reduced showed some of the serious consequences for children born at a time when there were limited services.  These consequences are still being managed now, by schools and secondary services, where timely prevention could have helped.

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