Conti, G; Dow, A; (2021) Using FOI data to assess the state of Health Visiting Services in England before and during COVID-19. UCL Department of Economics: London, UK.

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Abstract

Background: The first 1001 Days have been recognised as a critical window of opportunity and recent policy developments (e.g. Early Years Healthy Development Review) have identified the Healthy Child Programme (HCP) as central for achieving this. Health Visitors (nurses or midwives who have received further training as Specialist Community Public Health Nurses) are responsible for leading the HCP. However, there is substantial variation in the delivery of Health Visiting services across the country. Additionally, the COVID-19 pandemic has caused further disruption, with many health visitors redeployed from their current roles to the frontline. However, the exact state of the Health Visiting services before and after the pandemic is not precisely known. Our aim is to evaluate the state of health visiting services prior to COVID-19 and the exact scale and variation in redeployment of health visiting staff during the first COVID-19 wave. / Methods: Primary data collection via Freedom-of-Information (FOI) requests in 151 UpperTier Local Authorities (UTLA) in England. Primary outcomes are the number of full-time equivalent (FTE) health visiting staff employed in health visiting teams on 1 February 2020, and the maximum number of FTE health visiting staff who were redeployed during the first COVID-19 wave. We show graphical visualizations of the state of the health visiting workforce in England via maps, and we study the determinants of workforce size, composition, caseload, and redeployment via regression analysis. We also provide an analysis of job postings for health visiting roles collected on the ‘DWP - Find a Job’ website. / Findings: Health visiting was under severe strain before the COVID-19 pandemic. The mean caseload was 409 children per full-time equivalent (FTE) caseload holding health visiting staff on 1 February 2020, higher than the recommended maximum of 250 children per FTE health visitor. During the first COVID-19 wave, health visiting staff were redeployed out of their roles supporting young children and families. 66% of local authorities redeployed at least one FTE member of staff in health visiting teams. Redeployment of health visitors ranged from 0% to 63%, and of clinical skill mix staff supporting health visitors from 0% to 100%. Health visiting staff were redeployed from 19 March 2020, as England went into its first national lockdown, for an average duration of over 2 months. Redeployment was still in place until September 2020, and in 73% of local authorities that redeployed staff, it continued past June 3 2020 (the date of the supposed restoration of health visiting services by NHS England). There was also a large decline in job postings for health visiting roles at the start of the pandemic, suggesting that the posts lost due to redeployment were not replaced. / Interpretation: The findings show extensive and unequal redeployment of health visiting staff during the first COVID-19 wave across English local authorities. This happened on top of a state of high pressures on health visiting teams prior to the pandemic, with staff responsible for worryingly high caseloads. This situation threatens the universality of the Healthy Child Programme, and calls for appropriate policy responses to avoid the possible worsening of inequalities in maternal well-being and child health and development. / Funding: European Research Council under the European Union’s Horizon 2020 research and innovation programme (grant agreement No. 819752 DEVORHBIOSHIP – ERC-2018-COG, PI G. Conti) and Leverhulme Trust (via the Philip Leverhulme Prize in Economics to G. Conti).

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