TopicsGrowth & DevelopmentLeft holding the baby

Left holding the baby

As health visitor numbers reach an all-time low, Joanna Day examines the link between the loss of community children’s services and increased workload and stress on remaining health visiting teams.

I began my health visiting career as a part of the Implementation Plan of 2011-15, entering practice in 2013. This year, I have left a job that I loved and families I had worked with for many years because I could no longer reconcile the service I was able to deliver with the service I believe the families deserve. A key contributing factor to the current recruitment and retention crisis is the loss of additional community children’s services and the knock-on effect that this has had.

Centre closures

Community services have been reduced and removed at an ever-increasing rate. Government statistics show that by last June 1342 centres had closed over the past decade and 50 councils had seen children’s centre numbers reduce by half. For example, Birmingham has seen a fall from 75 centres in 2010 to 35 centres in 2021 (UK Parliament, 2022). The closure of children’s centres and removal of the Sure Start offer has had a massive impact on the service delivery of health visitors.

As children’s centres close their doors or reduce their opening times, families are left without baby and toddler groups to attend, a safe place to go for support or access to family support workers. Despite knowing that group settings do not always attract the at-risk families, the offer in my practice area moved family support workers out of home-based support and into group provision. The loss of family support workers who could support families in their own home has a significant impact on the practical and emotional support available. This has left health visiting teams trying to fill this void.

Early intervention is one of the foundations of the health visiting profession and the loss or redeployment of support staff from children’s centres has, in my experience, had a big impact on health visiting team caseloads, as well as family perceptions of and satisfaction with the service. Whereas previously families could be signposted to social groups or referred for family support with key skills including budgeting, parenting, literacy and emotional health, health visiting teams are now trying to offer a holistic, safe service to ever-increasing numbers. As safeguarding caseloads rise, the families who require support in the early stages of difficulty cannot be prioritised.

High staff turnover

Interprofessional working has become more strained as services reduce. Social care colleagues are under increasing pressure, with high staff turnover and caseloads, and can be difficult to contact. Information-sharing that is widely acknowledged to be crucial to avoid siloed working has become harder and harder, putting children and families at risk. The HV is often the only professional who has known the family for some time and can find themselves trying to manage ever-increasing risk alone. Relationships with social work colleagues are vital for protecting children from harm, yet the current working environment makes maintaining them very challenging. Interprofessional relationships are further strained by changes to referral processes so that services are increasingly failing to reach those who need them the most.

‘the closure of children’s centres and removal of sure start has had a massive impact on service delivery’

Self-referral services are often simply not appropriate for the most vulnerable families who lack the motivation, time or understanding to engage. Similarly, an ‘opt-in’ service provided by other community services only serves to increase HV workload; time spent completing re-referrals for services that HVs know a child or family needs to access continues to increase, along with additional time spent encouraging and checking in with families to engage. We cannot be an ‘opt-in’ service; we are universal and for all.

Safeguarding threshold

Provision of support for the families most in need but who do not meet a safeguarding threshold has become highly challenging. Gone are the days of supporting families in accessing basic everyday needs such as cookers or carpets, and our availability to advocate for families in unsuitable housing or difficult conditions is ever-decreasing. Many HVs find it impossible to provide this service, which has long-lasting consequences. These include increasing childhood illness because of poor living conditions, poor diet owing to lack of cooking facilities or knowledge and financial hardship due to not qualifying for support. Once again, the service aim of early intervention is becoming impossible, and the implications of this are far-reaching.

The HV is the one constant for these families – the person who tries to support and empower them while juggling many families in similar or worse situations. We need to be proud of what we have achieved and continue to achieve for the families we serve. However, we need to recognise that this is a wider issue with political roots caused by public spending cuts, which is not something that individual practitioners can resolve by themselves. We could work for 24 hours a day and it would still not be enough. Instead, we need to think collectively, using our skills in advocacy to push for improvement, particularly in these times of ever-increasing austerity. Proposed strike action is an opportunity for those who wish to show their commitment to service improvement and raise awareness of the importance of health visiting teams. We need to put pressure on decision-makers to look at the very real consequences of the mass exodus of HVs and the links between professional attrition rates and funding for services.

Try not to work in the evenings or at weekends, although we know that ‘work to rule’ is easier said than done when there is risk involved. Advocate for yourselves. Engage with your unions and Unite-CPHVA – your voice is important and it deserves to be heard.

There is no simple solution to this issue, although there are common threads – financial and political investment. Community services and the lives of our children need investment. We know how important the First 1001 Days are, and we need help to provide the best support and service possible. We need adequate community support to improve outcomes for children and families while retaining a skilled, passionate and experienced workforce.

Joanna Day is lecturer in children and young people’s nursing at Birmingham City University.


UK Parliament. (2022) Children’s centres. See: (accessed 3 February 2023).

Image credit | Shutterstock


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