Figures show drop in health visitors in West Yorkshire and more appointments done virtually

There's been a big drop in the number of health visitors across parts of Yorkshire, and more appointments are being done virtually instead of in person.

Health visitors are trained nurses or midwives who work with families to give support and information during the early stages of parenthood.

The mandated contacts by health visitors are an antenatal visit before the baby is born, a new birth visit at 10-14 days, and reviews at 6-8 weeks, 9-12 months and 2-2 ½ years.

Figures we obtained via FOI requests show Leeds, Bradford, Wakefield and Kirklees have all seen a fall in full-time health visiting staff coupled with a rise in families on the system.

In Kirklees, the 6-8 week visits are also routinely offered by phone rather than face to face unless there is a specific need or risk, although any concerns flagged during the call can then be followed up by an in-person visit. Over the border in Calderdale the visits remain face to face, despite both services being provided by the same organisation.

The data from Kirklees also shows that more than 3,000 antenatal visits – around 65 per cent - are not being completed each year. The number of health visitors dropped from 55.5 in 2021 to 45.7 this year, whilst the number of patients on the system rose – suggesting the number of patients per full-time health visitor increased by 60 per cent.

Victoria from Holmfirth needed mental health support after the birth of her baby but was only picked up because a GP decided to follow up and ask if she needed help after seeing her for the initial post-birth medical check. She reckons it's becoming easier for problems to slip through the net:

“It’s luck unfortunately with a lot of these services. It was just because I saw one GP more than once. And I feel like if somebody knows you, even a little bit, even if they’ve only seen you once, they can pick up when something’s not right. It’s that continuity of care that unfortunately, both in health visiting services and the NHS, we don’t really have any more because we can't afford it.

“I know that because I’m confident and don’t take no for an answer I got the help I needed, but a lot of people possibly wouldn’t. So I think unless you know something is out there or know to push for it, it’s really hard.”

We spoke to Victoria at a breastfeeding group where some of the other mums gave us their thoughts on the idea of some health visiting appointments being offered virtually rather than in person:

“You could tell that they’re also checking out the surroundings while they’re there,” said Tracey.

“My health visitor asked where my daughter was sleeping and things like that. They need to see the baby definitely, I work in social care and you just need eyes on people sometimes. Also just to put a face to the name, I wouldn’t have felt as comfortable asking questions if it had been over the phone. Particularly around breastfeeding, that is quite a physical thing in terms of to show and check it was right.”

Evangeline said: “It might be your only contact with humans that you’ve had in a while. Some mums don’t get out much straight away, I know I didn’t with my first.”

Rebecca runs the group and told us they’re picking up lots of mums who didn’t find much support elsewhere: “For so many people when it’s your first baby, you have no idea what you’re doing. You don’t know if your baby’s getting enough or if they’re happy. And there’s not that many spaces where parents can go just to check in and get that reassurance that they’re doing okay.

“I think if parents have real clear and urgent mental health needs, the perinatal health team tends to be good. But there’s a huge amount of parents who have some mental health difficulties that might not seem to be urgent and pressing, but actually for themselves and their babies and their families they are. They might not quite meet what’s expected to fit in the perinatal mental health team but they are struggling and we pick up a lot of those people here.”

In Leeds, the number of full-time health visitors dropped from 149 in 2021 to 129 this year, although this does represent a slight increase on last year’s figure. In Leeds Outer West, video calls are being piloted for the antenatal check. Leeds Community Healthcare NHS Trust says home visits are still done when a ‘targeted’ or ‘specialist’ need has been flagged though, and if a need is identified during a video call a face-to-face home visit is then arranged.

Bradford also saw a drop in health visitors, whilst the number in Calderdale increased.

Data from the Harrogate and District NHS Foundation Trust, which provides the health visiting service for Wakefield, shows a similar drop in health visitors coupled with a rise of families on the system. The service says 6-8 week and 9-12 month checks are also routinely done by video call across North Yorkshire.

In a joint statement, Kirklees Council and Locala Health & Wellbeing (which provides the health visiting service for Kirklees) told us the recruitment of health visitors is an ongoing national issue.

The council said: “In line with government guidance, families are offered five main health visiting contacts or ‘visits’ for their children. The guidance also sets out that health visitors should use their clinical judgement to identify whether virtual, other digital or blended approaches can be used to support the needs of a child or family. Any family who requires targeted or more significant support will always be seen face-to-face.

“Kirklees Council works closely with Locala to make service improvements. Over the past two years we have increased the resources and capacity of the programme in line with national standards.

“While 6–8 week checks are generally taken over the phone, families who require additional support or who have vulnerabilities are always seen on a face-to-face visit. Also, any family who requests a face-to-face visit is now provided with one.

Locala Health & Wellbeing said: “We offer a combination of home visits, telephone and clinic contacts. This is in addition to our responsive duty health visiting team and text messaging service, which enable families to contact us between their appointments.

“We recently completed a comprehensive review of our entire 0-5 service via a survey shared to all families. While full analysis is currently in progress, early insight shows that between 2023-24, 99% of families and carers state that they would rate the Health Visiting service as very good or good. 90% of families or carers state that they felt supported.”

We also asked Leeds Community Healthcare NHS Trust and Harrogate and District NHS Foundation Trust for a response.