ENGLAND — The Institute of Health Visiting called for safe staffing limits to be introduced on health visitors' caseloads in England. Some health visitors in England are responsible for more than 1,000 families each, while other UK nations operate with safe staffing limits of about 250 caseloads per health visitor, a level that has not been applied in England.

The number of health visitors in England fell from 10,200 a decade ago to 5,575 in January, a drop of 45%. The reduction in staff has led health visitors to take on an increasing number of families. During the pandemic, health visitors in almost two-thirds of hospital trusts were redeployed by the NHS, a decision the Covid inquiry last year described as "fundamentally flawed." Health visitor reviews with families have broadly returned to pre-pandemic levels.

"We need to set a benchmark, otherwise we're just going to continue to see this decline with hugely unmanageable, unsafe caseloads which are impossible for health visitors to work within," said Alison Morton, chief executive of the Institute of Health Visiting. Morton said there are not currently enough health visitors employed in England to provide the level of coverage that safe staffing limits would require.

"Health visitors are having to prioritise, and actually prioritisation has a human cost," Morton said. "I'm sorry, I can't do that extra follow-up visit when you know it would have made a massive difference to that family."

Families in England should receive five health visitor appointments from late pregnancy until a child is two years old, with the first three visits taking place in the home, according to NHS and government advice. That guidance is not currently being followed consistently across England. In Scotland, families receive 11 mandatory visits, and in Northern Ireland nine.

Ruth Watts, a registered health visitor, said drop-in services were being stretched. "Mums may have plucked up the courage to come in that day to talk about their mental health, but then they can't come if there's no slots available," she said. "We're seeing a massive rise in vulnerable families and families that are requiring more from a health visitor." Watts said that with the decline in health visitors, people and parents are reaching more and more for social media, and that it should never be seen as a replacement for speaking with a health visitor face to face.