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Improving outcomes for children and families in the early years

A key role for health visiting services

Health visitors have a long history. The role dates back to the 1860s – and over the years they’ve been there for many millions of families, providing valuable support in those early years. That continues today with parents now guaranteed five visits before their child turns three.

In 2015 health visiting was brought into the local government fold for the first time since 1974. It gives councils a unique opportunity to build on what has been achieved and help make progress in key areas of public health.

Just consider the four domains of the current public health outcomes framework: improving the wider determinants of health, health improvement, health protection and reducing premature mortality. Health visitors can have an impact on all of them through their work in supporting families in the early years, identifying those in need of extra help and ensuring good uptake of immunisations programmes.

The result of such support cannot be underestimated. It builds resilience, encourages healthy lifestyles and aids social and emotional development. So it has been
welcome that we have seen a significant investment in health visiting in the past five years. The numbers were increased and the service has been transformed. But what can councils do to continue and build on this momentum?

As with so much of public health, the move into local government offers fresh opportunities. By integrating health visiting with other services, such as children’s
centres, early help, safeguarding and public health teams, we can provide better support to children and their families.

But of course times are tough. Austerity is biting hard and public health funding is being squeezed. Councils have to juggle competing demands and deliver with scarce resources.

Make no mistake, though, what happens at the start of life has a major impact on the life chances of children. Health visiting services, working in partnership with other health and community services, can help ensure that start is positive. What could be more important than that?

Health visitors are registered nurses or midwives who have completed extra training in specialist community public health nursing. They lead or form part of a wider health visiting team that can also include nursery nurses, health care assistants and other specialist health professionals.

They lead and deliver the Department of Health’s healthy child programme (HCP) for children aged 0 to five along with other health and social care colleagues, including family nurse partnership teams. The HCP goes on to cover those aged five to 19, but this element involves school nurses rather than health visitors.

The HCP is offered to all families and the core elements include health and development reviews, screening, immunisations, social and emotional development, support for parenting and health promotion.

The National Institute for Health and Care Excellence describes health visiting as a “vital service” which can “build resilience and reduce costs later in life, tackle inequalities and promote healthy lifestyles”. It says the service offers a unique opportunity to reach out to families because it is “valued and accepted” as a universal service.

The HCP and health visiting became the responsibility of councils in October 2015, completing the transfer of public health functions from the NHS to local government.
The vision for health visiting was set out five years ago with the launch of the Health Visitor Implementation Plan in 2011, a joint initiative between the Department of Health, NHS England, Public Health England and Health Education England.

At the heart of the plan was improved access, experience and outcomes for all families. To enable this to happen the government promised to increase the health visiting workforce, to make up for an earlier fall in staff numbers and an increase in the birth rate. Although the target of 4200 extra health visitors was (just) missed, the workforce increased to the point of enabling a ‘minimum floor’ of one full time health visitor for each 300 children under five years to be employed.