Researchers from University College London have been exploring the delivery of health visiting services to children in England. The results are mostly positive. They found that health visiting teams are reaching nearly all babies and most children under five with face-to-face contact. In addition, they are providing a high number of additional visits to children in many local authorities, although the duration and location of visits varied across the country. However, a significant minority of children are still being missed by health visiting services: for example in some areas, up to 10% of families were not receiving the new birth visit and up to 82% were not receiving their 6-8 week review.

These findings, published in the International Journal of Population Data Science (IJPDS), were derived from data from Health Visiting Service Delivery Metrics data and a subset of the Community Services Dataset between April 2018 and March 2020.

The health visiting service in England leads the delivery of the government’s Healthy Child Programme for children under five. The Programme includes five universal health reviews during the third trimester of pregnancy, at child age 10-14 days, 6-8 weeks, 12 months, and 2-2½ years. Each review has a schedule of health promotion activities, and provides contact details and/or referrals to specialist services for children and families in need of additional support.

From 2015, the responsibility for commissioning public health services for children aged 0-5, including health visiting, was transferred from the NHS to local authorities. However, local authorities and their provider partners have faced funding cuts, low numbers of health visitors and high levels of family need, putting pressure on the service. Despite this, results from this study suggest that there is still a significant public health infrastructure to support the health and development of babies and children and the wellbeing of their families in the critical period before school.

The study did produce a notable finding however, that a considerable percentage of visits lasted less than 45 minutes. This raises questions on whether there is a minimum time feasibly needed for health visiting teams to build relationship with parents, work in partnership with families, undertake health promotion work and conduct a holistic needs assessment of the whole family and family environment.

The substantial variation in the visit’s frequency, duration, and medium of additional visits is unlikely to be explained fully by differences in underlying needs of the families. Other contributing factors may include local service provision and service priority, budgets, personnel capacity, and the availability of other local services. Further work is required to understand why models of service delivery are so different across areas. Studies based on the most up to date data are also needed to investigate service delivery following the partial stop of health visiting services, widespread redeployment of staff, and a change to virtual contacts during COVID-19 pandemic.

Also of importance, this research highlights the need to strengthen the transferring and reporting of data to improve completeness and representativeness.

Dr Jenny Woodman, Associate Professor in Child and Family Policy at UCL adds: “There is still a gap between health visiting activity and need - but for us the story here is that pre-pandemic, despite challenges with workforce and funding there existed a high coverage and, in some cases, very intense public health infrastructure for under 5s. This infrastructure can be built on and strengthened to support families and improve the health and wellbeing of our youngest members of society.”

 

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Dr Mengyun Liu, Research Fellow, Institute of Child Health and Institute of Education, University College London.

Liu, M., Woodman, J., Mc Grath-Lone, L., Clery, A., Bunting, C., Bennett, S., Kendall, S., Kirman, J., Weatherly, H., Barlow, J., Bedford, H. and Harron, K. (2024) “The Variation in health visiting for the under 5s: A cross-sectional analysis of administrative data in England for 2018-2020”, International Journal of Population Data Science, 9(2). doi: 10.23889/ijpds.v9i2.2382.