When Covid-19 arrived, everything changed for health visitors.

While many people think of the profession as specialist nurses supporting families with pre-school children, their role is much broader. Health visitors work closely with nursery nurses, GPs and social workers, providing antenatal and postnatal support. They advise on parenting skills, assess the family and home situation, and monitor children’s growth and development.

Since lockdown, many services in England have had to stop or severely restrict face-to-face appointments in homes as health visitors have been redeployed to other healthcare roles. This has led to concerns about being able to pick up on vital clues about people’s mental health, particularly new mothers; children’s development; and domestic violence.

“We expect children are having a difficult life in households with domestic abuse,” says Jacky Syme, a service development manager at Bedfordshire community health services. “The level has gone up, we’ve seen it on the ground.”

Calls to the UK’s national domestic abuse helpline have reportedly risen by 66% during lockdown and visits to its website increased by 950%. Demand for beds in refuges has also rocketed.

“There is a lot of concern around vulnerable children behind closed doors,” says Cheryll Adams, chief executive of the Institute of Health Visiting.

“Health visitors are always looking for vulnerability and if they’re not out there seeing families, how much is slipping through? There are lots of knock-on effects of this virus that we’re still understanding.”

Witnessing domestic violence as a child can have a huge impact on their future and mental health, Adams adds.

The profession had already been hit hard by a decade of austerity and several thousand staff in England lost their jobs following cuts to public health budgets.

As a result, children and families in England now receive a very basic health visiting service, says Adams. Even before coronavirus struck, a survey by the institute found 80% of families in England don’t see a health visitor formally after their six to eight week review. The effect of this, as well as consequences of the pandemic, will mean health visitors may struggle to pick up on some issues families are contending with.

These include important interventions such as helping mothers who may be victims of domestic abuse, supporting couples to help prevent relationship breakdown, early identification of perinatal mental health issues, and having time to provide concentrated support where mothers are struggling to bond with their babies.

Alis Rasul, a district clinical manager for health visiting at Birmingham community NHS trust, manages a team who have had to adapt quickly to the challenges of lockdown. They still carry out house visits for the most vulnerable families, but all other appointments are done by phone.

This worried Rasul and her colleagues. “Phone interventions can never compensate for home visiting,” she says. “Health visitors do worry about using their professional judgment over the phone. It can be difficult but we have rapport-building skills and can pick up on things.”

She cites one case where a health visitor was not able to catch a new mother on her own, as the father was always lurking in the background. One day, she forgot to pass a message on in a scheduled appointment and so rang back later. The father was not present so she took the opportunity to talk about domestic violence with the woman and tell her that services were still open. The mother said nothing at the time, but rang the health visitor a week later. Rasul rememembers: “The mother had had a terrible argument with her partner where he had abused her and she said she wanted to leave. The health visitor arranged [for her to get the appropriate help].”

Both Rasul and Syme have had to launch campaigns to tell their communities that services have remained open throughout the pandemic.

Syme fears the Covid-19 crisis will lead to an increase in postnatal depression, which is usually picked up early by health visitors visiting homes. “This has an impact on babies because they’re not the centre of the mother’s world,” she says.

Families also face rising poverty, with some people losing their jobs overnight and waiting for universal credit payments, meaning they are under more financial stress and may find feeding their children difficult.

Rasul adds: “We’re going to have a generation of post-Covid children who will need a lot of interventions. There will be speech and language and developmental delay that wasn’t picked up over the phone.”

• Call the 24-hour National Domestic Abuse Helpline, run by Refuge, on 0808 2000 247. Women’s Aid’s online chat can be found here