After the government launched a concerted drive to recruit more health visitors – whose numbers had over the years become dangerously low – a disaster was averted, as targets set in 2011 to train more than 4,000 health visitors by 2015 were successfully hit.
But now all that hard work is under threat after responsibility for health visitors and school nurses was transferred from the NHS to local authorities in the same year.
The latest figures show that the numbers of health visitors in the NHS are steadily falling – there were 9,410 whole time equivalent health visitors in 2016, compared with 10,309 the year before. A similar pattern emerged among school nurses – 2,561 whole time equivalent school nurses worked in the NHS in 2016, compared with 2,725 the year previous.
But Unite believes the scale of the problem of declining community nurse numbers will remain hidden because there’s no overall accounting of the number of these nurses now working for local councils.
“The lack of an overall ‘controlling mind’ about the number of health visitors and school nurses working for local government will hamper workforce planning and lead to a fragmentation of services for families with babies and young children,” explained Unite lead professional officer Obi Amadi.
“NHS health visitor numbers have been dropping almost consistently from month to month since October 2015, when the workforce was at its largest size recorded in more than a decade,” she added.
“Families with young children and babies are facing a ticking health time bomb because of the sorry and sad decline in health visitor and school nurse numbers – this can’t be right for a strong preventative public health policy.”
The ‘ticking health time bomb’
Unite member and health visitor Veronica Steele, who has worked in the NHS for more than three decades, can attest personally to this ‘ticking health time bomb’.
“We’re always very short-staffed, and we’re always being asked to do more than we can do,” she explained. “Now that local councils are commissioning our services, they’re requiring us to do a lot of social care – it’s very hard for us to do the nursing care all while addressing the social needs of our clients.
“I’ve got to the point where I’m thinking – how am I going to serve my clients, how am I going to give them my best if I’m pressed for time because we’re so understaffed and under-resourced? I love the job and I think it’s valuable but we’re asked to do more with less resources. It’s becoming impossible – we have to have a rethink.”
It’s not only community nursing that’s under threat – other public health services are also feeling the pressure.
A new King’s Fund report published today (March 14) found that despite NHS acute and specialist services grabbing all the headlines in the national conversation about health funding cuts, these services have been for the most part protected – it is public health that’s suffering most.
Even though the public health grant increased once services were transferred from the NHS to local authorities, this did not last long. In 2015-16 public health budgets were cut by nearly £200m, with councils now being asked to make hundreds millions more in savings by 2020-21.
“The government needs to secure the future of community nursing by increasing and ringfencing money for these professions and the vital work with families that they carry out on a daily basis,” Amadi argued.
“The ‘public health’ purse strings are now held by local councils, struggling with unrelenting cuts from Whitehall. While, in theory, public health budgets are ringfenced, in practice, council bosses can interpret what constitutes ‘public health’ in flexible ways.”
Indeed, today’s King’s Fund report found that the public health budget is ‘quite leaky’ – the think tank heard from people they interviewed that some councils were defining spending on services such as parks as falling within the purview of public health.
The King’s Fund investigation said that the direction of travel, in which public health services are being left behind, “suggests the NHS is moving further away from its goal of strengthening community-based services and focusing on prevention, rather than making progress towards it.”
Amadi reiterated the call for vigilance over community nursing workforce numbers.
“What we fear is that overall workforce planning for health visiting and school nursing will fall between the NHS and local authorities – such a split can’t be the best way forward and would be another example of further NHS fragmentation,” she said.
She pointed too to the 44 new Sustainability and Transformation Plans (STPs), which she called “the latest Trojan Horse aimed at privatising NHS services for corporate profit.”
These STPs divide England into 44 regional areas and are essentially plans to introduce NHS reforms by making massive savings – they were recently given a significant £325m funding boost by the chancellor Phillip Hammond in the budget.
Unite researcher James Lazou said that STPs would have serious implications for public health because they represent another top-down reorganisation that’s historically proved to be so detrimental for services such as health visiting.
“STPs’ entire raison d’être is to deliver a huge amounts of cuts,” he said.
Unite head of health Sarah Carpenter warned that STPs would usher in yet another wave of NHS privatisation – the way they create separate health economies would prove “very attractive to large private sector companies who have interests in running health services.”
“The fact the only funding given to health is to put money into STPs gives us concerns about [the government’s] motivation,” she told the Independent last week. “STPs are quite sneaky in themselves. There are no structures, no accountability… It’s all very shady.”