Understaffing means half of health visitors (51%) are struggling to deliver mandated health checks to families with children, warns the Royal College of Nursing (RCN).

A new report from the College highlights the impact of the long-term failure to invest in key children’s nursing roles, specifically health visitors and school nurses. It says the situation has created a “ticking time bomb” for public health.

Health visitors and school nurses support babies, children and young people, and their families, in protecting their health across a range of areas, including physical and mental health, and are central to preventing ill health into adulthood.

The College is warning government that there is “no hidden army of health visitors or school nurses” and is urging ministers to unite the public around new investment to boost the workforce and protect children’s health.

An RCN survey of health visitors and school nurses working in England saw (51%) of health visitors say that understaffing creates challenges in meeting mandatory health visiting contacts, a series of health and development reviews for all families with children, from 28 weeks of pregnancy through to when the child is 2 and a half years old.

However, understaffing means many are missing out on these vital health interventions, with just under 3 in 5 (57%) health visitors confirming that their service currently offers all mandated health visiting contacts.

Meanwhile, in schools, nearly three-quarters (73%) of school nurses believe workforce shortages are having a major negative impact on the support available to children and young people, with a limited capacity to deliver health promotion initiatives on issues such as mental health, healthy eating and immunisations.

Overall, more than half of health visitors (58%) and school nurses (56%) said understaffing was leading to reduced time for prevention and early intervention. Almost two-thirds (64%) said administration and bureaucracy take up “a lot” of their time.

One health visitor told the RCN:

“Health Visiting is very different now to how it was when I first started. We are reactive rather than proactive. Very little time spent on public health promotion. Safeguarding is at unprecedented levels and cases are far more complex. Staffing levels are a joke.”

Another health visitor said:

“Our work is rooted in public health, prevention, and early intervention, and although much of what we do isn’t easily measurable, its impact is profound and long-lasting.

“Yet, despite our essential role, health visiting is often undervalued. Commissioners frequently seek to reduce costs, sometimes halving the support offered to families. I’ve seen firsthand how this can lead to stripped-back services that fail to meet the needs of communities.”

A school nurse said:

“It just feels that we are delivering our role with one hand tied behind our back and are being expected to be continually make concessions to what we are able to deliver due to lack of funding and reducing the number of staff in our teams for financial savings.”

The RCN calls come against a backdrop of failing children’s health with evidence showing child obesity and child mortality increasing, while Type 2 diabetes diagnoses among under-25s is rising too.

The report comes after, in January this year, the Health and Social Care Committee called on the government to recruit 1,000 extra health visitors immediately to address the “major shortage”. The Committee said it was not given the confidence that “ministers are acting quickly enough to support health visitors, or that there is any intention to scale up the workforce to a level that will even touch the sides of what’s needed.”

The RCN is now urging the government to rapidly expand the health visiting and school nursing workforce and to provide the necessary funding to restore the public health grant to at least its 2015 levels. There must be ring-fenced funding for children’s services and support for universities to expand health visiting and school nursing courses and placements.  

RCN General Secretary and Chief Executive Professor Nicola Ranger, said:  

“These findings show the extent to which children and young people are being failed. At the heart of it is a chronically understaffed workforce, unable to deliver crucial interventions, a situation which effectively condemns the future of our country to a lifetime of poor health. When government fails to invest in prevention it is only storing up costly problems for the future.

“The reality is there is no hidden army of health visitors and school nurses waiting in the wings to transform care, deliver crucial advice, immunisations and to ensure families and children and young people get the right care, right when they need it. There are no clinical professionals better placed to help improve health outcomes, but they need the support of government.

“The evidence shows that children’s health is declining and it’s a ticking time bomb for government. If their commitment to moving from sickness to prevention is to mean anything, then ministers must waste no more time and invest to grow the health visitor and school nursing workforce.”

 

Ends

Notes to editors

 

Prevention Starts Here: Health visitors, school nurses and children’s health in England - 27 May 2026

Health and Social Care Committee - The First 1000 Days: a renewed focus

Government refuses to set targets for health visitor recruitment or to develop new vaccinations strategy – 22 April 2026

Available workforce data for these roles is limited but shows that since 2015, the number of NHS-employed health visitors has fallen by almost half (-46%), while the number of NHS-employed school nurses has declined by 29% (with qualified school nurses declining by 26%).

Freedom of Information requests sent by the RCN to local authorities to try to fill the gaps in workforce data found just 322 qualified school nurses working outside of the NHS in England and just 1,381 health visitors. However, the data was patchy and inconsistent and most concerningly, around a quarter of local authorities were unable to provide any workforce data for their commissioned services.

Amongst health visitors:

• Only 7% of health visitors reported their service to be fully staffed, with one in five saying they were severely understaffed.
• 65% told us that understaffing had increased their caseloads and workloads.  
• 62% said there is increased stress and burnout as a result.  

Amongst school nurses:

• Only 23% said that their school nursing service is fully staffed, and one in six described their service as severely understaffed.

• 64% reported higher caseloads and 56% increased stress and burnout because of understaffing.  
• Nearly a quarter (23%) said they are looking to leave school nursing altogether  

Methodology

In August/September 2025, the RCN ran a survey for Health Visiting and School Nursing members in the UK on a range of topics including work/caseload, service delivery and capacity, the needs of service users and retention challenges. The target audience was identified through RCN membership data and sent a link to the online survey via email. The survey was open for a period of four weeks and collected both quantitative and qualitative data. The questionnaire and data tables are available on request. We received a total of 307 responses from England, representative of the broader school nurse and health visitor workforce, and these have been extracted and analysed for use in this report.

In April 2025, the RCN Policy & Public Affairs Department sent two FOI requests to 153 local authorities in England (based on the list of local authorities in receipt of the Public Health Grant allocations for 2025-26). One FOI request focused on health visiting and one focused on school nursing and included questions related to the workforce (full list of questions available on request).

In cases where local authorities responded to say they did not have the information and requested that we contact the provider directly, we sent out a second round of FOI requests to providers. We also sent the request directly to providers when only a partial or no response was received from the local authority.

1 -Office for Health Improvement and Disparities (2024a) Child health profiles 2024: Statistical commentary. Available at: Child health profiles 2024 - GOV.UK

2 - The Food Foundation (2024a) A Neglected Generation: Reversing the decline in children's health in England. Available at: TFF Children's Health Report SEPT.pdf

3 - NHS England (2024a) Children and Young Adults (0–25 years) diabetes toolkit. Available at: NHS England » Children and young people diabetes toolkit