As a new grandmother and a health visitor who trained in the 1980s, I have been observing a personal and very stark difference in the support of families with young children that has arisen over the last 40 years. It is a situation I recently discussed with my daughter-in-law when she was describing how she is accessing information and guidance for the care of her 9-month-old baby son.
The shortage of health visitors and the change in commissioning of services has resulted in many first-time parents having no access to health visitors in those crucial first few weeks and months. In this environment, digital applications have now become the central – and sometimes only – source of support. They are brilliant for immediate access and available 24/7, and I have no doubt any new parent with a smartphone will be using them to very good effect.
There are various digital platforms that provide the opportunity to measure feeding, sleep, activity and developmental milestones. For my son and daughter-in-law, breastfeeding advice in the early days was gathered from breastfeeding helplines, the local National Childbirth Trust cohort and numerous websites – some, unfortunately, with conflicting information. Similarly, weaning advice was collected from various websites and trusted sources. Development has been measured within the local peer group, comparing when and how each baby achieved a milestone, but with no opportunity to speak confidentially to a health visitor if any concerns arose.
My son and daughter-in-law have had no home visits from a health visitor and there is no regular drop-in clinic for them to attend to discuss any concerns with their baby's progress. When the service is appropriately funded and commissioned, the health visitor would have been central to providing expert advice on every aspect of baby and childcare, including feeding, sleeping, weaning, and the identification of any developmental delay, with onwards referral. They would also have been able to provide guidance on the best evidence-based apps to use to help to navigate the conflicting advice, and signpost or refer for any additional help and support.
One of the joys of health visiting in the days that I practised was building a relationship with the family, reassuring them as needed, and addressing the physical, mental and emotional health and wellbeing of all members of the family, including the new baby. None of this can be done with what my daughter-in-law experienced – a brief phone call to ask how the baby is at 2 weeks old and a promise of a clinic appointment in the next few months.
Baby immunisations were given at the GP surgery where the general practice nurse (GPN) is entirely competent in vaccinations (and much, much more) – but GPNs are not trained as experts in child development and child health.
The consequence for many parents with no health visiting service available is that they are left ‘feeling their way’ with no single source of the truth. Some will request frequent GP appointments for reassurance about the normality of what they are experiencing, or they visit the emergency department with minor issues that could have been resolved at a health visitor clinic.
The stresses and the anxieties experienced as a first-time parent should never be underestimated. The impact on parents can be overwhelming and a health visitor is the single most qualified health professional to support the entire family. It is heartening to know that the new Labour government is committed to increasing the number of health visitors in the next 5 years, recognising their value in the community and acknowledging the increased demand on local primary and emergency care services when the health visiting service is under-funded and depleted.
The Institute of Health Visiting (iHV) has tracked the decline in health visitor numbers over the last 9 years, noting a 37% decline since 2015 (iHV, 2022).
This figure provides the new government with a target to at least restore health visitor numbers to what they were 10 years ago, giving hope that there will be a re-balancing of priorities in prevention and health promotion, resulting in a positive whole-system impact and a healthier population in the years ahead.