Responsive Facility: Patterns of health visiting contacts and child development in England 2020-2024

Dates

May 2025 – July 2026

Research Team

Professor Jenny Woodman - UCL (project co-lead), Dr Louise McGrath-Lone (project co-lead), Professor Katie Harron, Dr Gareth Hagger-Johnson, Dr Diane Stoianov

Why we are doing this study

The health visiting service in England is designed according to a principle of ‘proportionate universalism’, meaning that all parents with children under age five should receive five ‘mandated contacts’ by health visitors from the third trimester of pregnancy to age 2½, but with scale and intensity varied in order to offer the most support where there is more need. The mandated contacts should comprise a health and development review of the babies or child, health promotion activity and a holistic assessment of family need. Families with identified need should then receive ‘additional’ contacts from the health visiting team and/or be signposted or referred to other services. However, health visiting is facing very serious operational challenges. There are increases in family need for support, decreases in availability of skilled workers, and decreases in service expenditure – which has fallen by almost 37% since 2016. In addition, there is high variation in the organisation, reach and intensity of even the mandated services across England, even before considering additional support that might be needed. There is also variation in data quality recorded and submitted about the visits, which is problematic. Good quality data about the visits is necessary, in order to evaluate the impact on visits on child health and development.

Evidence on the current delivery of health visiting services and child development age 2-2½ can inform government policies on strengthening health visiting and supporting child development in the early years. Our research team has previously conducted these analyses up to March 2020, but they now need updating.

Why this is important?

Setting every child up for the best start in life is a current UK government policy priority. The government has set a target for early child development (75% of children ready to learn by the end of reception year at school) and has recognised the key role of health visiting in supporting babies, young children and families by committing to ‘strengthening’ this service (Opportunity Mission, 2024).

What we will do

Our study uses national administrative data on health visiting (Community Services Dataset, CSDS) which we will link to Hospital Episodes Statistics (HES). HES contains information from all NHS-funded hospitals in England, including admissions and A&E attendances. CSDS are available from the 2015/16 financial year onwards, but are relatively incomplete until 2018/19. We currently have access to link CSDS-HES data up until March 2024, which will allow us to explore how birth characteristics (e.g. birthweight and gestational age) are related to patterns of health visiting. We will describe the data completeness in the available dataset since April 2020 and describe patterns of health visiting and child development age 2-2½ in the 2020-24 cohorts, which we have already done for the 2018-20 period (see our earlier published work in this area: Clery et al. 2024, Bunting et al, 2024 Liu et al, 2024, Jayu et al, 2024.)

In this new study we will use lay involvement and consultation with stakeholders to generate insights into why some families receive mandated contacts and others do not.

What we will find out

We aim to produce an up-to-date description of health visiting contacts and child development at age 2-2½ using the Community Services Dataset, with lay involvement and stakeholder work to give insight into why some families receive mandated contacts and others do not.