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Feature Feature

Scotland’s health visitor investment is improving child health and easing pressure on services

BMJ 2024; 384 doi: (Published 27 February 2024) Cite this as: BMJ 2024;384:q448
  1. Emma Wilkinson, freelance journalist
  1. Sheffield

England may wish to follow Scotland’s lead on preventive healthcare for under 5s, writes Emma Wilkinson

Urgent action is needed to tackle worsening health in children under 5 in the UK, the Academy of Medical Sciences warned last month. Poor rates of infant survival, increasing demand for mental health services, rising rates of obesity and tooth decay, and falling vaccination rates1 were all listed as areas to address.

The report2 called for efforts to increase the workforce for child and family health. According to the Institute of Health Visiting (IHV), England needs 5000 more health visitors to meet the basic requirement (mandated by regulation) of five visits between a child’s birth and their starting school.

Drop-in clinics have been scaled back in many areas following long term cuts in public health grants,3 and this year’s IHV annual report found that 79% of health visitors in England felt they lacked capacity to support children with identified needs. The average caseload is 409 children, despite 250 being the maximum limit recommended by the IHV and 300 by the government.

IHV chief executive Alison Morton says that, while services are variable throughout the UK, there is a “natural experiment” happening between England and Scotland because of the countries’ contrasting approaches to providing health visitor services.

“The investment in Scotland, where there is a more …

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