Are HV caseloads adding up?

08 February 2019

As one member crunches caseload numbers, another looks at data protection and the Named Person, and we highlight the HVs named in the New Year’s Honours list.


I read with interest Dave Munday’s Caseload crunch article in November 2018’s journal. His article outlined the changes in health visitor staffing numbers following the end of the Health Visitor Implementation Plan and the transfer of commissioning to local authorities in October 2015.

The article quotes the number of children on the average whole-time equivalent (WTE) caseload and compares it with the 250 children per WTE caseload benchmark recommended by Unite-CPHVA. The article reported health visitor caseloads in Worcestershire of 514. The methodology used to calculate the current average caseload is inaccurate for Worcestershire as we monitor active caseloads and work within integrated skill-mixed teams.

As all health visitors will know, there is a rich mix of needs within each caseload from those children and families requiring a Universal approach, to those requiring intensive support at a system level. All children within Worcestershire receive a public health service guided by the Healthy Child Programme up to the age of 27 months. At this stage, if their needs are assessed as being Universal they are no longer considered ‘active’ on the caseload. Should their needs change, they will be reinstated on the caseload and receive a Universal Plus or Universal Partnership Plus service. Based on our current caseload, this accounts for 91% of children under the age of five years. Of the remaining children, approximately 6% require some additional support (Universal Plus) and 3% require intensive support (Universal Partnership Plus).

Worcestershire Health and Care NHS Trust health visitor caseloads are monitored on a monthly basis by the service, taking into account the needs of the children and families. The average caseload for our registered health visitors is 217 children per WTE. In locations where there are significantly higher levels of need, the average caseload size is 207 children per WTE, and where the needs are predominantly universal the caseload size is 231 children per WTE.

Enabling health visitors to safely support children and families is essential to ensuring the best possible outcomes for the child and family, and therefore I would not support a caseload in excess of 500, which – as the article states – is more than double the recommended number.  

Sally-Anne Osborne is service delivery unit lead for children, young people and families and specialist primary care, Worcestershire Health and Care NHS Trust. 


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Data safeguarding and THE Named Person

The GIRFEC [Getting it right for every child] Practice Development Panel has been meeting regularly since early 2018 to support the development of a binding code of practice in relation to information sharing by and with Named Persons.

While all involved believe in the GIRFEC principles of providing early help and support to children and families who need it, Unite-CPHVA aims to ensure that information-sharing by practitioners is lawful and in accordance with data protection regulation, human rights and the common law of confidentiality. It is equally concerning and frustrating that lawful information-sharing without consent is likely to remain at the level of ‘safeguarding’ the child’s wellbeing.

If practitioners cannot share or receive information without consent to promote and support (that is, enhance) the child’s wellbeing, there seems little ‘added value’ to the Named Person role in legislation without a very real concern of only damaging the health visitors’ relationship with families by stigma creep.  

Annette Holliday is a health visitor and Unite-CPHVA Executive member for Scotland. 


Medal Alamy
It’s an honour

In the 2019 New Year’s Honours list, Ruth Oshikanlu, health visitor, parenting expert and author, has been appointed as a member of the order of the British Empire (MBE) for services to community nursing, children and families, and named an ambassador for the health-visiting profession.

Gail Powell, senior nurse and professional lead for health visiting at the Aneurin Bevan Local Health Board, was also awarded an MBE for services to health visiting.


What do you think?

The following are just a few of the topics that we hope to cover in the next few issues of the journal. If you would like to suggest an aspect of a topic that we should explore, if you have expertise in any of the areas, or if you would like to be interviewed on
a subject, please get in touch. Future topics will include Brexit, the anti-vaccine movement, tongue-tie, bereavement, foodbanks, and autism. And, as always, if you would like to comment on any of our published articles, email [email protected]
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