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‘ Children’ s services are pushed to the limit’
Helen Lewis, an ANP in general practice based in the South Wales Valleys, says:‘ We continued to see children and families during the pandemic and now we’ re seeing more children than even before the pandemic, and they are coming in with typical childhood ailments.
‘ Families are given the choice to come into the practice or have a phone consultation. But this choice is adding to workload – when you speak on the phone you may then still need to see them face to face. And when families come in, they are arriving with a“ shopping list” of issues.‘ There’ s a backlog in secondary care and we’ re expediting referrals, including for ultrasounds and ENT appointments. Some patients also don’ t understand why their child can’ t be seen straight away – dealing with their frustrations also adds to the workload.‘ There’ s good communication with our health visitors – they have an office in the surgery, so if we have a particular concern about a baby or child we can just visit them upstairs. But they are very stretched.
‘ Uptake of MMRs is not brilliant because of historical concerns – but to help deal with this our team contacts parents if they don’ t arrive for their appointments.
‘ The cost-of-living crisis is starting to filter through into general practice. We’ re seeing more families coming in who can’ t afford to fill their fridges up. We have a wellbeing officer who has been coming to the surgery since even before the pandemic and who helps patients deal with issues related to their household bills.
‘ There’ s a workforce shortage without a shadow of a doubt. People left during the pandemic so we’ re short staffed – recently I was the only clinician in the building. The Government needs to invest in making general practice nursing a more attractive option, and we need to get student nurses into primary care facilities.
‘ Children’ s services – as with other services in the NHS – are pushed to the absolute limit. We need to have an open line of communication with children’ s services as a whole, including social services and foster carers, because children’ s wellbeing is everybody’ s business.’
Nursing in Practice spoke to health visitors, school nurses and practice nurses to learn more about the problems they are up against.
‘ Hidden backlog of unmet need’ While government policy might suggest the pandemic is over, for health visitors it is a different story, says Ms Morton.‘ What our members are telling us is that the impact of the pandemic is not over for babies, young children and families,’ she explains.
‘ We’ re only just starting to recognise the wider impact on the largely hidden backlog of unmet need – those“ invisible” babies and young children, and vulnerable parents, including women with postnatal depression, who have always been a concern and who do not get the support they need,’ she says. The pandemic has meant some families have simply not been seen.
Despite health visitors’ best efforts, Ms Morton warns they are now‘ struggling to meet growing levels of vulnerability’ because of the workforce shortage.
‘ Referrals are escalating, and the shortage of health visitors means we have less time to do brief interventions and build relationships with families,’ says a health visitor in the Midlands, who asked not to be named.‘ We’ re also seeing a lack of early intervention because of the pandemic, which means families have got to crisis point before they come into contact with services, making it much harder to support them,’ she says.
In Cheshire, Hannah’ s son, born in 2020, has yet to see a health visitor.‘ During the pandemic I was told there were no face-to-face visits. Just recently, I called about my son’ s 18-month check and was told there were still no visits because of Covid. I’ m now being forced to“ go
It’ s a false economy not to prioritise babies and children – if we don’ t invest in them, we will pay the price for generations to come
ONLINE Scan the QR code to have your say on the issues raised, or visit nursinginpractice. com / analysis private” so that he can have a full check-up,’ she says.’
Even when checks are carried out face-to-face there is no guarantee they will be done by a health visitor. In the south of England, for example, one health visitor says two-year checks are being carried out by nursery nurses.
Ms Morton explains that the main drivers behind the shortage of health visitors are cuts to public health funding and workforce attrition – with people retiring or leaving the profession due to burnout, and insufficient training places to make up for the numbers lost.
Under-resourced health visiting services are resulting in a‘ postcode lottery’ of access to support, with the risk that new parents experiencing mental health problems are being overlooked because of the service’ s‘ rapid deterioration’, according to the recent open letter to the Government co-signed by iHV.
This March, the Government said the five health visiting contacts mandated up to the age of two should be carried out face to face, amid concerns about virtual services not reaching the most vulnerable children. However, the letter states that‘ many families are not receiving the five health visiting reviews they are entitled to, or these vital checks are being delivered remotely, which makes it harder for professionals to identify perinatal mental health problems’.
Indeed, whether or not a family receives the five mandated health visitor contacts itself appears to be a postcode lottery. One health visitor in the south of England says she and her colleagues are doing more than the mandated five visits, while another in the Midlands says that while they are seeing families,‘ the picture varies very much across the country’.
Nurses, alongside nursing bodies and charities, are campaigning hard to raise awareness of the pressures facing health visitors. Ms Morton says iHV is advocating on behalf of babies, children, families and health visitors, as well as working with organisations like the Parent Infant Foundation‘ to showcase different, effective health visiting services to make people understand what the role involves and the positive impact it has’.
‘ More money and more health visitors’ is what the iHV wants from the Government.‘ In the Autumn Spending Review, we joined with partners calling for a £ 500m ringfenced uplift in the public health grant,’ Ms Morton says.‘ This would start to address the national shortage of 5,000 heath visitors. We also need a focus on quality to end the postcode lottery.
‘ It’ s a false economy not to prioritise babies and children – if we don’ t invest in them, we will pay the price for generations to come,’ she warns.
Concerns about child health support General practice nurses( GPNs) are working‘ over their normal hours and still not getting through all their workload’, says Heather Randle, RCN professional lead for education and primary care.
Now that people are beginning to socialise more again, she says GPNs are seeing more cases of chickenpox, stomach bugs and other common children’ s conditions.
More families are returning to their GP practice for face-to-face visits, some with multiple conditions that need treating. Bradford-based GPN Naomi Berry says she is catching up with referrals, and supporting distressed patients waiting for appointments in secondary care.‘ It’ s the norm now to have to say,“ Sorry you’ re having to wait” – it’ s upsetting and frustrating,’ she says.
Ada Allen, an advanced nurse practitioner based in Leeds, is finding that families are anxious about