Health Visiting during COVID-19 and beyond: the impact on children and families

Local Government Association webinar: Supporting the development of babies and young children during the COVID-19 outbreak

Thursday, 23rd July 2020

Alison Morton Director of Policy and Quality, Institute of Health Visiting

©Institute of Health Visiting 2020

The Institute of Health Visiting is a charity and academic body. Its core purpose is:

❖To improve outcomes for children and families and reduce health inequalities through strengthened health visiting services

Key messages from the Institute of Health Visiting

Presentation key messages:• Impact of COVID-19 and the Community

Prioritisation Plan on already depleted health visiting services

• Primary and secondary impact of COVID-19 on children.

• Restoration of services - What have we learnt? Are we reaching vulnerable children? What do we need to learn more about?

©Institute of Health Visiting 2020

Stay Home, Protect the NHS, Save Lives

16th March – Government announced measures to:

• Reduce spread of COVID-19 across the country

• Prepare for, and respond to, the anticipated large numbers of COVID-19 patients who will need respiratory support.

COVID-19 Prioritisation within Community Health Services

• Providers of community services requested to “release capacity to support the COVID-19 preparedness and response”

• Virtual by default – supply of PPE

• Workplace adjustments/ Shielding of staff at higher risk

Who was looking out for the needs of children?

©Institute of Health Visiting 2020

Guidance to “Stop – Partial stop – Continue”

Health Visiting categorised as “Partial Stop”:

Stop except:

• Antenatal contact

• New baby visits

• Other contacts to be assessed and stratified for vulnerable or clinical need (e.g. maternal mental health)

Advice from PHE,

“The presumption should be that all contacts will be virtual – using video-enabled technology or, failing that, telephone contacts. There will need to be an individual assessment of compelling need for face to face contacts at home and then decisions re PPE”.

©Institute of Health Visiting 2020

What is the primary impact of COVID-19 on children?

• WHO Coronavirus disease dashboard – UK data for all age groups:

• 292,556 confirmed cases; • 45,119 deaths (WHO, 18.07.2020)

• Deaths in children have been extremely rare (0.01%)

• 1,354 recorded cases in children 0-4 years

• 5 children have died of COVID-19 in the UK

• 71 have had severe symptoms that needed treatment in ITU (Paediatric Intensive Care Audit Network data, 24th June 2020)

• While children appear to be protected from the clinical effects of the virus, the secondary impact of the pandemic is significant.

Number of coronavirus (COVID-19) cases in England as of July 16, 2020, by age and gender

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Secondary impact of COVID-19 on children

Increased need/ impact:• Mental health – stress and anxiety• Loneliness • Couple conflict• Domestic Violence and Abuse• Alcohol consumption for some groups• Food poverty• Increased unemployment • Child Protection/ Child in Need – “pressure

cooker homes” – safeguarding referrals increased

• Falling immunisation rates – uptake fell by 20% in early weeks – returned to baseline but catch up still needed

Support scaled back

Whilst all families are impacted by COVID-19, the most detrimental effects are being felt by those who are already disadvantaged – in particular, our most vulnerable infants and children whose needs are often hidden from sight.

Groups of vulnerable children dataWhat do we know? (NB groups are not mutually exclusive and there are many groups for which estimates are not available)

CYP who may be at higher risk due to family and social circumstances and may not

be known to services. In England:

• 2m children living in absolute low income

• 40,990 homeless family households

• 27,265 parents* newly presented to specialist drug or alcohol treatment services

• 11,887 first time entrants to the youth justice system

‘Stat-Xplore’ tool, Department for Work and Pensions; Child Health Profiles, PHE; Adult substance misuse statistics

from the National Drug Treatment Monitoring System, PHE; Child Health Profiles, PHE

* Also includes unrelated adults living in a household with children

CYP who are at increased risk due to family and socially circumstances where there

is a statutory entitlement for care and support. In England:• 399,510 children in need; 52,260 children the subject of a child protection plan

• 78,150 children in care

• 1.3m pupils with SEN; of these, 271,165 with EHCP/SEN statements

• 132,345 pupils with Autistic Spectrum Disorder as primary needCharacteristics of children in need: 2018 to 2019;. Children looked after in England (including adoption), year ending 31

March 2019; Special educational needs in England: 2019. Department for Education.

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Data sources and estimates in development

• Revised Shielding list

• Those that have been negatively impacted from delayed presentation

• Those that may have been impacted by delay for planned / elective treatment or

reduced uptake of immunisation and early year support

• CYP with mental health needs will require specific support. Mental health needs may

increase with the duration of the response

Clinically Vulnerable

Higher risk and have statutory entitlement for care and support

Higher risk due to wider determinants of health / other factors leading to

poor outcomes

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Service Transformation

Learning more each day than I thought was possible,

Adapting to change, new, temporary ways of working,

©Institute of Health Visiting 2020

The impact of COVID-19 on the ability of community-based practitioners to keep babies and young children safe [who is keeping the baby in mind?] Preliminary findings (Barlow, 2020)

• Redeployment:• Health visitors had the highest rate of redeployment (compared to

MW and SW)• 1/3 of redeployed practitioners reported inadequate preparation for

the new role• Redeployment to a range of settings - hospitals, district and

community nursing, and adult services

• Critical services were not delivered• HVs concerns regarding the secondary impact of COVID-19

on children and families/ unidentified and unmet need• Cessation of universal visits meant that ‘new’ and

‘increased’ vulnerability not identified; not seen by anyone.

• Significant delivery of services virtually with:• no preparation/training; • no evidence regarding its use with these families; • many families not able to receive care that way; • most wouldn’t use it with vulnerable families going forward

• Changes have had a significant impact on the mental wellbeing of the workforce

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Restoration phase – where next? Is returning to “normal” good enough?

“Fully restore service, with some prioritisation where indicated and as capacity dictates”

©Institute of Health Visiting 2020

“Levelling Up”: a population AND individual approach

Based on Bronfenbrenner’s Ecological Systems Theory

Pre-conception Pregnancy

0-2 years

Schoolreadiness

Perinatal mental health

Healthy coupleRelationship/ DVA

Prevention of maltreatment

Reducingunintentional

injuries/ homesafety

Parentalhealth literacy/

Managing childhood illnesses

Substancemisuse/tobacco/

alcohol

Teenageparenthood

Breastfeeding Immunisations

Sleep

Infant mental health/ self-regulation

Childdevelopment/early language

Complex health needs/ disability recognised

and supported

Oralhealth

Healthy weight/

physically active

FAMILY/ PARENTAL CAPACITY

CHILD

PreventionEarly

identification

Engaging families-

recruitment/ retention

InterventionSafety net for

all childrenImproved outcomes

©Institute of Health Visiting 2020

Learning from COVID-19It is vital to avoid a blame game, with fear and silence standing in the way of learning and improvement… ‘embracing wholeheartedly an ethic of learning’ in the next phases of the response. Kings Fund, 2020

Our recommendations: • HV services should be reinstated as a matter of urgency as a vital support and safety-net for

children, with appropriate measures put in place, including the use of PPE, to reduce the spread of the virus.

• HV services must be fully prepared for any future waves of COVID-19. NHS England should revise the Community Prioritisation Plan (for phase one pandemic management) and develop clear messages on the importance of continuation of the service to ensure the needs of children are prioritised. This should include removing wording on the redeployment of health visitors.

• A clear workforce plan is needed to ensure that the service has sufficient surge capacity to manage the backlog of missed appointments, as well as demand for support due to the secondary impacts of the pandemic.

• An evaluation of the use of virtual, non face-to-face service delivery methods is urgently needed to determine their effectiveness for identification of vulnerabilities and risks, impact on child and family outcomes and reducing inequalities to inform future digital change.

• A cross-government strategy is needed to reduce inequalities and “level-up” our society - this will require investment to strengthen the HV service which plays a crucial role in the early identification and support of the most disadvantaged families.

• The impact of working during the COVID-19 pandemic on staff wellbeing cannot be underestimated - a proactive plan is needed to ensure staff have the right support during the restoration of services and to create high quality workplaces for all staff in the future.

©Institute of Health Visiting 2020

Our Vision for the future - how do we get there? Three priorities

Workforce

QualitySustainable

funding

The evidence is clear, the solutions are there. If not now…. when?

©Institute of Health Visiting 2020

Thank you

Contact details:

Alison.morton@ihv.org.uk@Alison_Morton2

• info@ihv.org.uk

• www.ihv.org.uk

• Telephone number 0207 265 7352