Health visiting services risk “falling off a cliff” without urgent investment in the workforce, MPs have been warned.
Alison Morton, chief executive of the Institute of Health Visiting (iHV), told the Health and Social Care committee this week that services had been “decimated” and called for the government’s upcoming spending review to prioritise money for child and family services.
“Parents are demanding more health visiting support and we cannot provide it to them, and we want to”
Alison Morton
Her comments came as part of a renewed inquiry by the cross-party parliamentary committee into the first 1,000 days of life.
The committee that was previously in place in 2019 published a report on the topic and found significant variation in provision for families in the first 1,000 days.
Now, the current committee has chosen to revisit the subject, to see whether any progress has been made on the issues raised in 2019.
This week, MPs heard a second evidence session focused on local authority provision of early years services through the family hub model.
There are currently around 400 family hubs open in England across all 75 local authority areas.
They provide universal and specialist support services for families with children aged 0-19 or up to 25 for young people with special education needs and disabilities.
Despite health visitors playing a key role in family hubs, Ms Morton warned that the workforce numbers had depleted significantly and it was having an impact on service provision.
“We’ve seen a 43% drop in health visitors since 2015 and 19% of that was since the announcement of the family hub,” she said.
“So, we need to put our money where our mouth is and fix this problem, because it’s having a huge impact.”
Ms Morton cited previous cuts to the public health grant as something that “directly correlates with cuts to substantive health visiting posts”.
She further noted that the recent cuts to funding for level 7 apprenticeships would have an “impact on health visitor training” and routes into the specialty.
Despite dwindling workforce numbers, demand is increasing for health visiting services, MPs were told.
The iHV’s 2025 State of Health Visiting report found that demand for health visitors had risen in the past 12 months, with only 45% of English health visitors reporting being able to provide continuity of care to families.
“Health visiting is a specific branch of nursing that needs extra special attention”
Alison Morton
Ms Morton warned that a health visitor in England could be dealing with a caseload of between 500 and 1,000 families.
She noted that England was an “outlier” compared to its UK counterparts, with Scotland, Wales and Northern Ireland dealing with caseloads of around 200 to 250 in comparison.
“They’ve got an unmanageable caseload,” Ms Morton explained.
“There’s no bottom to this. This is going to keep falling off a cliff until somebody puts a line and says ‘that’s too many, nobody can cope with that, it’s unrealistic’.”
MPs pressed Ms Morton on what could be done to address health visitor workforce shortages and increasing demand, to which she said “funding is the backbone”.
“Health visiting is a specific branch of nursing that needs extra special attention,” she argued.
“Health visiting was invented in England and, across the globe, countries are copying us and yet we’re watching our service become decimated – I think it’s a wake up call.
“I really hope I have the ears of all of you here to bang the drum.”
Ms Morton said her specialty had “the support from every single professional body across the UK” that all agreed “we need more health visitors”.
She added: “They cannot all be wrong and, actually, parents are demanding more health visiting support and we cannot provide it to them, and we want to.”
The inquiry heard how health visitors could be key to delivering the government’s three big shifts for the NHS: moving care from hospitals into the community, shifting services from analogue to digital and moving away from sickness to prevention.
“Health visitors are in a really strong position to support those shifts,” Ms Morton said.
“But it won’t happen unless we invest in the workforce.”
Next week, the government will deliver its spending review, which will set out the budgets of government departments until the end of the decade.
Ms Morton told MPs she hoped investment into health visiting and children’s services would feature in the review.
She said: “We’ve got a workforce ripe and ready. What they want is a government to stand up and say ‘we back our health visitors, we support them and we show you this by putting out words into action, and we’re going to invest in you’.
“So, I’m hoping that might be the outcome of the spending review.”
