When the Covid-19 pandemic swept across the United Kingdom in March 2020, the National Health Service (NHS) faced an unprecedented crisis. Hospitals braced for a surge of critically ill patients, and in the scramble to meet demand, thousands of health visitors—specialist nurses who support families with young children—were redeployed to other parts of the NHS. But as the ongoing Covid inquiry has revealed, this decision may have left some of the nation’s most vulnerable children dangerously exposed, with consequences that, in the words of one expert, were both "life-changing and life-ending."
Alison Morton, chief executive of the Institute of Health Visiting, did not mince words when she addressed the inquiry. According to the BBC, she described the redeployment as "fundamentally flawed" and "inappropriate," emphasizing that health visitors "were needed most on their own front line." Instead, many were sent to hospitals, administrative roles, or even tasked with delivering parcels and answering phones. "Children were being harmed by these practices," Morton told the inquiry. "It had life-changing and life-ending consequences for these children and they were the canary in the coalmine and we needed to listen to them and make their voices count even in their deaths." She added, "For me, it was the most sad part of the pandemic, how we let those children down."
The scale of the redeployment was staggering. University College London research presented to the inquiry found that health visitors in almost two thirds of NHS trusts in England were moved from their usual roles in March 2020. The intention was to bolster the NHS response to the pandemic by freeing up staff for critical care. However, the fallout was immediate for those left behind. Some health visitors who remained in their posts were suddenly responsible for caseloads of 750 children or more—triple the recommended maximum of 250, according to evidence from Professor Catherine Davies of Leeds University.
The Institute of Health Visiting, a charity and professional body, was quick to note the dangers. It raised concerns with the government as early as summer 2020. But it was not until October, months after the redeployment began, that NHS England’s Chief Nursing Officer, Duncan Burton, sent a letter to trusts ordering an end to the practice. Even then, the Institute had to intervene again in December 2020 to prevent a repeat redeployment, as revealed during the inquiry.
Behind the statistics are stories of real tragedy. The inquiry heard about children like Star Hobson and Arthur Labinjo-Hughes, both killed by their guardians during the pandemic, whose deaths made national headlines. But, as Morton pointed out, "there were many others." Research by the child safeguarding review practice panel, shown to the inquiry, identified the shift from home visits to virtual check-ins as a factor in several serious incidents and deaths. Virtual visits, while necessary for infection control, often failed to pick up on signs of abuse or neglect that would have been apparent in person.
"Some children paid the highest price," Morton stated, referring to those who died as a result of missed interventions. The loss is not just measured in lives. Professor Steve Turner of the Royal College of Paediatrics and Child Health told the inquiry that children were "hugely and in some cases irretrievably damaged" by the indirect effects of the pandemic. "They are 25% of the population and get 11% of the NHS spend," Turner noted. "They are not treated equally in our society and became a lower priority in the pandemic and in the recovery period."
NHS England’s Duncan Burton defended the decisions made at the height of the crisis. He explained that the NHS was "dealing with a new virus and staff had to be freed up to help with critical services." Although he insisted that "safeguarding activity did not stop throughout the pandemic," he acknowledged that it "did change." For example, staff at testing centres were trained to spot safeguarding concerns, and guidance for online interactions was updated to factor in the needs of children. But the inquiry was also told that the NHS made a conscious decision to keep children out of the healthcare system unless absolutely essential, pausing elective procedures for children in March 2020 to free up beds for critical care.
The consequences of these choices are still being felt. NHS data presented to the inquiry showed that children’s waiting lists grew at twice the rate of adult waiting lists during the recovery period after the pandemic. Burton’s evidence suggested that children’s procedures were "seen as less of a priority compared to, for example, adult cancer treatment," due in part to the fact that children’s operations are mainly conducted in specialist hospitals with a smaller workforce. One of the most acute areas of backlog is in speech and language therapy, with schools reporting a huge increase in students needing additional help.
Many in the sector feel these issues were predictable and preventable. The Institute of Health Visiting said it was in regular contact with the government throughout the summer of 2020, warning of the risks. Yet, as the inquiry heard, it took months for action to be taken. The subsequent letter from the Chief Nursing Officer in October 2020, and the need for a "strong intervention" to prevent a further redeployment in December, highlighted the delays in recognizing the problem’s severity.
The inquiry’s current phase is focused on the impact of the pandemic on children and young people, and whether their needs were adequately considered in key government decisions. The questions being asked are difficult but necessary: Did the drive to protect the NHS come at too high a cost for children? Were the most vulnerable left without the support they desperately needed? As more evidence is heard, the answers will shape not just the legacy of the pandemic but the future of safeguarding and child health policy in the UK.
The picture painted is one of a system under immense strain, making impossible choices in the face of a crisis. Yet, as Alison Morton and others have made clear, the consequences for children were profound and, in some cases, irreversible. As the inquiry continues, the hope among advocates is that the lessons learned will ensure that, should another crisis arise, the voices and needs of children will not be overlooked again.
