The National Health Service’s (NHS) decision to redeploy health visitors during the early days of the COVID-19 pandemic has been described as “fundamentally flawed,” with significant harm caused to vulnerable children, according to the head of a leading health visiting charity. The remarks came during evidence presented to the ongoing Covid inquiry, shedding light on the unintended consequences of the NHS’s response to the pandemic.
Alison Morton, the CEO of the Institute of Health Visiting, told the inquiry that the redeployment of health visitors—who are usually tasked with supporting families with young children—was “inappropriate,” especially given that these professionals were needed “most on their own front line.” Health visitors typically play a crucial role in safeguarding children and ensuring their well-being, particularly in the early years of life, when intervention can be the difference between a child’s healthy development or exposure to neglect or abuse.
During the early months of the pandemic, many health visitors were reassigned to other areas of the NHS to support hospitals and frontline workers dealing with the acute impact of COVID-19. The intention was to bolster staffing in hospitals and urgent care services. However, the redeployment process was not without its issues, and the inquiry heard how health visitors were sent to work in various roles, including administration, delivering parcels, and answering telephones, rather than being placed directly in critical healthcare settings.
In a statement to the inquiry, Morton said: “We let families down. Protection was not afforded to babies, and some children paid the highest price.” This, she argued, was not merely a side effect of a global health crisis, but a systematic failure to prioritize the protection of vulnerable children during the pandemic.
A “Fundamentally Flawed” Decision
According to research conducted by University College London, health visitors in nearly two-thirds of NHS trusts in England were redeployed as early as March 2020. These actions resulted in severe consequences for many families and children who were left without adequate support during a period of intense vulnerability. Some health visitors who were not redeployed were left with caseloads that far exceeded the recommended number, with some managing up to 750 children—three times the acceptable limit of 250. This overwhelmed staff and limited their ability to offer personalized and critical support.
The inquiry also heard that the child safeguarding efforts, including home visits by health visitors, were severely compromised. With face-to-face visits replaced by virtual consultations and remote check-ins, many families who had been suffering in silence were not able to be properly assessed, leaving children in potentially harmful situations. According to Morton, this was a failure to listen to children’s voices, especially those who were suffering due to neglect or abuse.
The inquiry was shown evidence from the Child Safeguarding Review Practice Panel, which linked the shift to virtual visits as a contributing factor in the deaths and serious incidents of children during the pandemic. Two cases, in particular, were highlighted—those of Star Hobson and Arthur Labinjo-Hughes, who were both tragically murdered by their guardians during the pandemic. While these high-profile cases brought national attention to the issue, Morton made it clear that many more children experienced harm, underscoring the widespread nature of the problem.
“Children were being harmed by these practices,” Morton stated. “It had life-changing and life-ending consequences for these children. They were the canary in the coalmine, and we needed to listen to them, even in their deaths.”
NHS Response to Safeguarding During the Pandemic
Duncan Burton, the Chief Nursing Officer for England, also gave evidence to the inquiry. He acknowledged that while many health visitors were redeployed to assist with acute services, the NHS response to safeguarding children remained a priority throughout the pandemic. However, he emphasized that the way safeguarding was delivered had to adapt to the changing circumstances. Burton explained that staff in testing centers were trained to identify signs of child abuse, and online consultations were introduced to replace in-person visits. He argued that this adaptation was crucial to maintaining some level of safeguarding activity, despite the overwhelming pressure on the health service during the pandemic’s peak.
However, many experts, including Morton, argued that these measures were insufficient. The replacement of in-person visits with virtual consultations, especially for vulnerable families, created a barrier to identifying at-risk children. Morton’s criticism was pointed: “The voices of children were lost,” she said, adding that the NHS failed to fully understand the implications of their actions on children’s safety during this time.
The inquiry also highlighted that the government’s approach to keeping children out of the healthcare system unless absolutely necessary, as well as pausing elective procedures for children, contributed to delays in vital healthcare interventions. At the height of the pandemic, NHS resources were diverted to critical care, leading to a backlog of non-urgent treatments. While urgent cases continued to be addressed, the overall effect was that children’s needs were deprioritized.
Long-Term Effects on Children’s Healthcare
The consequences of this decision are still being felt today, as children’s waiting lists for healthcare services have grown at twice the rate of adult waiting lists during the post-pandemic recovery period. Data from NHS England shared with the inquiry indicates that children’s procedures were viewed as less of a priority compared to treatments for adults, especially in areas such as cancer care.
As a result, children’s health services saw unprecedented delays. For example, the waiting list for speech and language appointments grew significantly, with schools reporting a massive increase in the number of students requiring additional help. Delays in diagnoses and treatment for conditions like speech disorders, developmental delays, and other health needs may have long-term impacts on children’s overall development.
A Call for Accountability and Change
The Institute of Health Visiting has been in regular contact with the government since the summer of 2020, raising concerns about the impact of redeployment on health visitors and the resulting harm to children. In October 2020, a letter from the Chief Nursing Officer for England to NHS trusts called for the end of health visitor redeployments, but the damage had already been done.
Morton’s testimony at the inquiry paints a grim picture of a system that failed to protect some of the most vulnerable members of society—children. The tragic consequences of these decisions, she argues, should serve as a stark reminder of the importance of safeguarding in the healthcare system, especially in times of crisis.
While the inquiry is still ongoing, it is clear that the decisions made during the early days of the pandemic had a profound and lasting impact on children’s health and safety. Moving forward, experts like Morton are calling for a more balanced approach to crisis management—one that doesn’t sacrifice the well-being of vulnerable populations in the name of expediency.
As the inquiry continues, it is hoped that the lessons learned from these mistakes will lead to meaningful change in how the NHS and other institutions respond to public health emergencies, ensuring that children’s safety and health are always prioritized, even in the face of a crisis.
