HV caseload crunch

07 November 2018

Dave Munday, lead professional officer at Unite, looks at how inflated caseloads are causing health visitors in England to struggle.

Case Crunch iStock

Since the end of the Health Visitor Implementation Plan in March 2015 and the transfer of commissioning to local authorities in October 2015, NHS health visitor numbers in England have mostly gone one way – down. The most up-to-date statistics show that 2399 health visitor positions disappeared between October 2015 and June 2018, a staggering 23% (NHS Digital, 2018).

Sadly, due to changes in the way the government recorded the numbers of health visitors in December 2015, this is only part of the picture. This study intends to reveal as full a picture as possible.


Sifting the data

My first step, in February, was to ask health visitors on social media who employed them, using the hashtag #FindTheHV. Of the 152 local authorities commissioning health-visiting services, 123 remain with the NHS. There are 13 employed in social enterprises or community interest companies, 10 employed by local authorities, five areas that commissioned private companies to provide staff and one GP federation.

Next, the aim was to discover the number of health visitors employed by non-NHS employers. For local authority employers, this was easy. The 10 local authorities received Freedom of Information requests and, with a reminder, I got data for all of them. For the social enterprises and community interest companies, six responded to my request, three said that they wouldn’t supply the data because they weren’t required to, and three did not reply. The request to one social enterprise went awry, but with a follow-up their results were quickly shared. Private companies and the GP federation ignored the request.

HV Caseloads Estinmated to be under 250
Using the data on health visitor numbers and combining this with a tool from the Local Government Association, which identifies how many under-fives live in each authority, I was able to work out average caseloads.

I first published these figures in my blog in September, following an article in The Observer (Campbell, 2018) based on my work.

The figures are a work in progress: I’ve repeatedly encouraged people to contact me to highlight any errors.

The first person to get in touch, for example since September, revealed that I’d been over-generous with reporting Brighton and Hove’s figures, originally at 73 under-fives per whole-time equivalent (WTE) HV. This mistake was caused by not realising that the staff provided for Brighton and Hove also covered West Sussex, and the figure has been amended to 317.

Only 10 of the 136 organisations for which statistics exist have average caseloads below the 250 maximum that the CPHVA have long argued should be in place (see panel, left). And 15 organisations have average caseloads of at least double the recommended maximum (500 or more).

We need your help

Dave hopes to improve the accuracy of the results, and monitor the change of HV employers over time. If you’re an employee or employer and have any information, contact [email protected]



Image credit | iStock



NHS Digital. (2018) NHS workforce statistics: July 2018. See: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-workforce-statistics/july-2018 (accessed 26 October 2018).



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