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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