Universal Health Visiting Pathway evaluation - phase 1: main report - primary research with health visitors and parents and case note review

8. Parents’ experiences during the COVID-19 pandemic

In addition to questions focusing specifically on UHVP aims and outcomes, the parents’ survey also included a small number of questions about experiences of the period between March and August/September 2020, when national COVID-19 restrictions were in place. The parents’ survey was conducted in August and September 2020 and while questions about the pandemic were not originally part of the evaluation, the changing landscape and impact on services, deemed it important to capture this for context.

Contact with health services during the COVID-19 pandemic

Half (51%) of parents reported that they had some contact with any health services since March 2020, while 48% had not had contact with any of the services asked about^[6]. Specific services contacted were:

• Health visitor – 32% of parents overall had contact (37% of these face-to-face, and 74% by another method^[7])
• GP – 21% had contact (51% face-to-face and 62% by another method)
• NHS24 – 11% had contact and (13% face-to-face contact and 88% by another method)
• Hospital (Non-urgent A&E) – 10% had contact (68% face-to-face and 40% by another method)
• A&E – 8% had contact (face-to-face in each case, though 2% said they had also contacted A&E through another method).

Parents of younger children were more likely to have had contact with health services since March 2020. This difference was greatest in relation to health visitors. Six in ten (59%) parents answering on behalf of a child aged one or under had been in contact with their health visitor since March, higher than parents of all other age groups (35% of parents of 2 year olds, 21% of parents of 3 year olds and 22% of parents of 4 or 5 year olds). Younger parents were also more likely to have had contact with their health visitor (43% of parents under 30, compared with 34% of 30-34 year olds and 28% of parents aged 35 years and above). There were no significant differences in whether parents reported having contact with their health visitor since March 2020 by area deprivation, urban and rural areas, or Health Board region.

Among parents who had had contact with their health visitor, there were certain groups less likely than average (37%) to have had face to face contact: parents answering about a four/five year old child (20%), parents with no other children in the household (22%) and parents working part-time/on maternity leave from a part-time job (20%).

Among the 68% of parents who had not had any contact with their health visitor since March, 20% said they would have expected to have some contact in this period, while 68% would not have and 11% were unsure. In line with the planned pathway visits, parents answering about children aged one or under were most likely to have expected to have contact (47%^[8]) while parents answering about children aged 4 or 5 years were least likely to have expected this (13%). There were also differences by deprivation level with 30% of parents in SIMD 1 and 2 (most deprived) saying they would have expected to see or speak to their health visitor in this period, compared with just 10% of those in SIMD 5.

For each of the health services, at least four in five parents were satisfied with the contact they had had since March:

• A&E – 98% satisfied (80% ‘very’ and 18% ‘fairly’)
• Hospital (not A&E) – 91% satisfied (65% ‘very’ and 26% ‘fairly’)
• GPs – 86% satisfied (57% ‘very’ and 30% ‘fairly’)
• NHS24 – 85% satisfied (60% ‘very’ and 25% ‘fairly’).
• Health visitors – 80% satisfied (47% ‘very’ and 33% ‘fairly’).

Parents were also asked how comfortable they were about accessing health services in person with their child or inviting a health professional into their home at the time they undertook the survey (August and September 2020). It is to be noted that at this point in time, COVID-19 cases in Scotland were substantially lower than they had been in the few months prior. Most parents expressed they were comfortable with accessing health and care services via face-to-face contact.

• 92% said they would feel comfortable with a health professional visiting them at their home in relation to their child tomorrow (50% ‘very’ and 42% ‘fairly’)
• 89% said they would feel comfortable visiting their GP with their child tomorrow (48% ‘very’ and 40% ‘fairly’)
• 83% said they would feel comfortable visiting A&E with their child tomorrow (43% ‘very’ and 40% ‘fairly’)

However, parents who were not working (76%) and those on lower incomes (£15,600 - £25,999) (73%) were less likely than average to feel comfortable about visiting A&E. Parents in the least deprived areas of Scotland were also more likely than those in SIMD 1, 2 and 3 to feel comfortable (91% versus 75%, 80% and 78% respectively).

Parents were asked about their own mental wellbeing during the lockdown period. Just over half (58%) said it had stayed the same, 30% said it worsened while 11% said it had improved. There were no clear patterns as to which groups of parents felt their mental wellbeing had declined – it did not vary significantly by SIMD, income, parental age, or age of child.

The small number of parents (6%, n= 32) with children aged under 1 year were asked about access to online peer support over the last few months. At least half said they had not needed any type of peer support (16 had not needed any support with infant feeding, 17 had not needed support with weaning and 24 had not needed any antenatal classes). Of the remainder, the vast majority said they had found online peer support very easy or fairly easy to access.