Health visitors ‘well placed’ to boost SEND support

The Institute of Health Visiting (iHV) held its first SEND Health Conference today (14 March) in Hertfordshire, focusing on the current priorities and issues for health visitors in England in supporting SEND families.

“Health visitors are well placed to be advocates for the voice of [a] child”

Nikki Freeman

At the conference, Nikki Freeman and Kirsty Jacques, both health visitor clinical leads for SEND at Hertfordshire Community NHS Trust, spoke about work they had done in their county to improve SEND provision.

The two specialist public health nurses pushed for the creation of a specific SEND pathway for health visiting.

Ms Freeman said that, before this, the quality and availability of health visiting care for SEND families across her county varied.

“It wasn’t that they didn’t want to deliver the care, but it may have been their confidence and understanding about what they as a health visitor could offer or do,” she told Nursing Times.

The pathway was created in 2019, and since then she and Ms Jacques worked within their trust to implement it and improve the SEND offer for young children and their families.

Part of this was improving risk assessments to allow health visitors to better decide what to do when a family declines to engage with the health visiting service.

Ms Freeman said this, as well as the “upskilling” of the Hertfordshire health visiting workforce, significantly improved care.

“Implementing the SEND pathway and making sure that staff are aware of the key points of contact that families can use,  and making sure they are doing a good assessment of that family’s needs and giving them information to relevant charities that support them, changed the support,” she said.

“Also, our risk assessments helped, so we don’t just keep phoning these parents, and instead have meaningful conversations.

“Upskilling our staff via training [also] made a massive difference; the iHV training on changing conversations in autism which we’ve delivered to nearly all of our staff now changed the language and how they talk and communicate with families.”

Ms Jacques said the pathway also helped health visitors adhere to their responsibilities under Section 23 of the Children and Families Act 2014 to notify the local authority of any children with additional needs – and the positives this brought.

“Provision in Hertfordshire wasn’t as good as it could be, so we kept on talking about it and since September last year we now have a very easy process for our staff to make a Section 23 notification,” she said.

“All healthcare professionals can do this, but it’s often the health visitors who are the first ones to see it. We have that duty.”

Ms Freeman and Ms Jacques said health visitors could still do more to help SEND children, including empowering parents to secure better educational support.

Ms Freeman said: “There is a gap in [SEND support] in early years education settings, and I think health visitors are well placed to be advocates for the voice of that child. Not upskilling the schools – that’s not our role – but giving parents the confidence to challenge the school.

“They can challenge them on issues such as reduced timetables, and say that the health visitor told them that they need a plan for four weeks to review; at present, they’re being left and don’t know how to cope or who to access in schools.”

Ms Jacques added: “Though we’re health, not education, those children on reduced timetables are sometimes only going in for 60-90 minutes per day – that has a huge impact on the whole family.

“Of course, that’s what health visiting is about, looking at the holistic need for the family and being advocates – filling a gap [other] local authority [services] can’t fill.”

The health visitors also highlighted the challenges a shrinking workforce had caused, pointing to the roughly 30% reduction in health visitors since 2015.

Alexis Quinn, a former professional swimmer and mother of neurodivergent children, told the conference about the benefits health visitors brought her – as a neurodivergent person herself – during her second pregnancy.

This included working with a midwife and health visitor before she gave birth to put a plan in place which recognised the sensory needs and additional help she required due to her autism.

She spoke positively about the flexibility of health visiting to meet SEND needs of parents, as well as the children.

Ms Quinn said the depletion of the health visitor workforce was “really concerning”.

However, she also noted that some adjustments to the service “don’t cost anything” and called on the workforce to be “especially curious” when a parent is not engaging.

Simon Kenny speaking at the event

Also at the event, Professor Simon Kenny, national clinical director for children and young people at NHS England, gave an overview of the current state of early years care.

Concerningly, he pointed to rising child mortality rates and English children falling behind their equivalents in other countries for developmental markers.

Looking ahead, Professor Kenny said: “We are aiming to have a shift away from acute care, from reacting to the problems, much more to a preventative strategy.”

He said he hoped to fill health visitors with “hope” that the decline they had seen in their workforce numbers “may be improved”.

He noted ambitions in the NHS Long Term Workforce Plan to increase the number of health visitors trained each year from 768 in 2022 to 1,339 by 2031.