Midwifery, health visiting and school nursing services play an essential role in ensuring the health and wellbeing of children from conception to adulthood, yet there are many issues affecting all three, which urgently need to be addressed.

The British Journal of Midwifery (BJM), the Journal of Health Visiting (JHV) and the British Journal of School Nursing (BJSN) publish a joint call to politicians and stakeholders to address issues affecting the services, such as:

  • Ageing workforce
  • Inadequate recruitment
  • Heavy caseloads
  • Low staffing levels
  • Lack of training
  • Need for fair pay.

Ageing workforce

The nursing and midwifery workforce is ageing (one in three UK-based nurses is over 50 (RCN, 2011), and the average age of midwives in England is 45-49 years). Effective recruitment and retention strategies are essential to ensure that these professions survive as so many nurses and midwives head towards retirement.

Inadequate recruitment

There are not enough midwives, health visitors or school nurses in the UK to meet demand, particularly at a time when increasing complex needs mean higher numbers ofstaff are necessary to deliver safe care.

Heavy caseloads

Caseloads are too large for midwives, health visitors and school nurses to be able to perform their roles safely and effectively. For example, it is has been estimated that the average school pupil in England has 12 minutes per year of school nurse time (CPHVA, 2014).

Low staffing levels

Sophie Gardner, editor of BJM, said: 'It is a well known fact that maternity claims represent the highest value and the third highest number of clinical negligence claims to the NHS Litigation Authority, yet the workforce remains grossly understaffed. It seems obviousthat increasing the workforce numbers, will not only help to deliver safe care to both mothers and their babies but also reduce the number of claims on the NHS thus free up funds to deliver fair pay for all.'

Need for fair pay

Despite a planned 1% pay rise for NHS staff, following several years of pay freeze, more work must be done to achieve fair pay in the current context of understaffing, increased pressures and rising living costs.

Lack of training

Alongside recruitment and retention, there is a need for ongoing training and continuing professionaldevelopment. Midwives, health visitors and school nurses would benefit fromtargeted training on specific areas of need, such as mental health.

Caroline Voogd, editor of BJSN, said: 'It is estimated that mental illness costs the UK over £100 billion per year and mental health services are struggling to cope. A well-trained and well-resourced midwifery, health visiting and school nursing workforce could help prevent many mental health problems escalating and reducing the costs and strain on mental health services.'

The joint article concludes: 'As long as midwives, health visitors and school nurses only have capacity to fire-fight and their services are not properly invested in, we will not be able to benefit from the long term changes they can bring to a population's health and wellbeing, and thereby a reduction in the economic burden of ill health.

'With a general election coming up, the British Journal of Midwifery, the Journal of Health Visiting and the British Journal of School Nursing are together urging the next government to address the issues we have highlighted to ensure the long-term health and wellbeing of the next generations.

'We need a government with enough courage and vision to see beyond its 5-year mandate, becauseserious and substantial investment, not lip service, is needed to bring sustainable change. Anything short of this would have disastrous consequences on the health of the population and generations to come.'

Madeleine Murphy, editor of JHV, said: 'There is a wealth of evidence demonstrating that a child's early experiences influence health and wellbeing throughout life, so it is essential for the future of our society that we ensure children and families get the best start.

'Integrated working and continuity of care among the midwifery, health visiting and school nursing workforces can provide a coherent approach to tackling the most pressing public health issues in modern life - such as obesity, poor mental health and substance misuse - and reducing the burden of ill health.

'A governmental commitment to long-term investment would ensure that midwives, health visitors and schoolnurses can continue to perform their roles effectively. They have the skills and dedication; they just need the political will to safeguard the servicesthey provide.'