A cut in the total number of Health Visitors in Birmingham, leading to many young children and families being seen less frequently, is likely from September 2017 when the new Early Years service becomes operational.
Birmingham City Council has recently started a competitive tendering process for the whole of the Early Years service, a service which now includes the Health Visiting service. A commissioning event attended by around 100 potential provider organisations took place earlier in July. A five year long contract worth £117m will be awarded in May 2017.
The new integrated Early Years service based around Children’s Centres is intended to more closely align different groups of early years workers supporting the under fives. It will work within a significantly reduced budget of £34m p.a. It is understood that the current budget for the Health visiting service is currently between £21million and £22million (1).
Freedom of Information requests by Keep our NHS Public Birmingham show there has been a significant increase in the total number (WTE) of Health Visitors employed in the city starting with 112 in 2011 and rising to 241 in 2015.
In this same period there has been a significantly reduction in caseloads from 731 children per Health Visitor (WTE) in 2011 down to 347 in 2015. (2) These local improvements were made under the national Health Visitor Implementation Plan 2011- 2015.
The purpose of the Health Visitor Programme, started in 2011, is to secure an extra 4,200 health visitors and transform the health visiting service across England by April 2015. Achieving this will help secure effective, sustainable services to support families to give all children the best start and to promote health and wellbeing in local communities. (3)
Local progress and sustainability achieved by the five year long Health Visitor Implementation Plan is likely to be threatened by the contraction of the available budget by about a third.
There was an admission that there may be job cuts from the City Council when it conceded recently to the Nursing Times that ”Regarding the potential for job losses…there will be a second phase of consultation with all stakeholders before any decisions are taken” (4)
Birmingham City Council had responsibility for the commissioning of Health Visiting services transferred to it in October 2015 together with the public health budget to fund the service. The Public Health Grant was transferred from NHS England to local authorities but it isn’t ring fenced.
The City Council raided these public health funds to mitigate a £5m cut in the Council’s spend on the total Early Years Budget in 2015-16. (5)
The Council budget 2016+ identified a further £15.3m cut in the Early Years budget planned over a three year period, reducing the total net spend on the Early Years service to £38m (which includes £3m for the costs of commissioning). (6)
The Public Health Grant of approximately £22m p.a. is being used to enable the overall reduction in contribution from the General Fund of the Council for all Early Years services. (6) The Health Visiting service will be operating within the £34m contract which is a smaller envelope of around one-third, but the public health grant is expected to form an increasing proportion of the funding for the remaining Early Years services.
Birmingham Community Healthcare Trust is the current NHS provider of the Health Visiting service. It is understood to be part of a consortium bidding for the Early Years contract.
The bottom line is that fewer Health Visitors will mean they have less time to support children and their families at a critical stage of their development.
(1). Birmingham health visiting ‘under threat from integrated service budget’ The Nursing Times 14th July 2016. http://www.nursingtimes.net/news/workforce/birmingham-health-visiting-under-threat-from-integrated-service-budget/7006440.fullarticle
(2). FoI response on Health Visiting service in Birmingham from Birmingham Community Healthcare Trust 14th July 2016. https://www.whatdotheyknow.com/request/health_visiting_service_in_birmi#incoming-838855
(3). The National Health Visitor Plan: progress to date and implementation 2013 onwards. https://www.england.nhs.uk/wp-content/uploads/2013/06/nati-hlth-vis-pln.pdf
(4). Birmingham health visiting ‘under threat from integrated service budget’, The Nursing Times 14th July 2016
(5). BCC Cabinet report from Strategic Director for People 29th June 2015 on Early Years Commissioning option for consultation
(6). BCC (2015) Budget Consultation 16+ Preventing Family Breakdown factsheet
(7) see Table on Page 3 BCC Cabinet report from Strategic Director for People 29th June 2015 on Early Years Commissioning option for consultation