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Mandation to continue for universal service five health visiting contacts: supporting the best start in life

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We know that what happens in pregnancy and early childhood impacts on physical and emotional health throughout childhood and into adult life. PHE evidence into action sets out the importance of children being ready to learn at 2 and ready for school at five as vital foundations for good health and development, and thus the importance of supporting families in these critical years.

Health visiting services are the lynch-pin of that support and this week the government announced its intention to continue the requirement for local authorities to commission five universal health visiting contacts for families.

The five contacts start at 28 weeks of pregnancy and continue up until the age of 2 and a half and form part of the Healthy Child Programme (the national child public health programme) alongside screening and immunisation programmes, health promotion and parenting support and more targeted interventions where needed

The mandation was put in place when the commissioning of the Healthy Child Programme transferred from the NHS to local authorities in Oct 2015. The mandated arrangements make clear that health visitors should lead the delivery of the HCP to improve outcomes for children, that effective assessment of need lies at the heart of a good quality public health service and that health visitors are the professionals skilled to do this  [link to Universal Health Visitor Reviews Advice for local authorities in delivery of the mandated universal health visitor reviews from 1st October 2015] .

In autumn 2016 DH commissioned PHE lead a review into the effects the transfer and in particular mandation. PHE worked with local authorities, other government departments and the NHS and based on the information provided the government has decided that the mandation should continue in line with that for other public health services

 So why does it matter?

The first 1001 days (from conception to the second year of life) is crucial to increase children's life chances.  The All Party Parliamentary Group Manifesto highlights the importance of acting early to enhance outcomes for children stating that that society is missing an opportunity if we don't seek to prevent problems before they arise.  These universal health visiting contacts are a vital to ensure that all parents are supported to give children the best start in life and when there are problems early additional help can be provided to improve outcomes.

They form a very visible offer to parents of highly skilled support with the transition to parenthood and at important points in child health and development.  Health visitors as highly trained specialist nurses are able to assess where families need extra help and to provide or arrange the right interventions

Health visitors and school nurses have been called the child public field force and through work with communities and  families have important roles to play in the delivery of other government priorities such as tackling childhood obesity, tobacco control (reducing smoking in pregnancy and passive smoking impact on children) and improving services and outcomes in perinatal mental health.

About the five contacts

  •  At 28 weeks pregnancy: Health Promoting Visit

The antenatal appointment is the first time that the health visitor will meet with parents and together they will complete the health needs assessment covering physical health (such as being smoke free and benefits of  breast feeding)  and emotional health (perinatal mental health).  The contact will include transition to parenthood, how parents can bond with their baby at the end of pregnancy and in the early days and help their baby’s early development.  The health visitor will explain the healthy child programme and the health visiting service to all families and identify those families who will need additional support

  • 10-14 days after birth: New Baby Review

The first visit made by health visitor at home after the baby is born, where health visitors will check on the health and wellbeing of the parents and baby, provide support with feeding and other issues and give important advice on keeping safe, and to promote sensitive parenting. This builds on the assessment of family risk and resilience factors started by the health visitor during the antenatal period.  Specific topics include early bonding and interacting with the baby, feeding and thriving (appropriate weight gain), the immunisation programme and safety such as car seats.  Parents often seek advice on establishing a routine and sleep; crying and colic.

  • 6-8 weeks old: 6-8 week assessment

This visit is crucial for assessing the baby’s growth and wellbeing alongside the health of the parent, particularly looking for signs of postnatal depression. It is a key time for discussing key public health messages, including continuing with breastfeeding, immunisations, sensitive parenting and for supporting on specific issues such as sleep. As well as this review their physical and emotional health visitors will also give contact details for the local health clinic, children’s centres and other local resources.  The health visitor will agree future contact with the family which may be the universal offer or ‘universal plus’ where extra help is given for issues such perinatal mental health, feeding and for babies with special needs

  •  9-12 months old : One year assessment

This is a review of the child’s development at 9 to12 months and will include development, growth and immunisation status.  It provides an opportunity to discuss with parents how to respond to their baby’s need and link parents with local family services and activities. It is a vital time to discuss child safety and nutrition and dental health.   It also provides an opportunity to identify where additional support may be needed, The health visitor is able to promote the two year free nursery offer at both the one and two year health reviews, improving school readiness for children from disadvantaged backgrounds.

  • 2-2½ years old (two to two and a half year review)

The universal two year review provides an opportunity both to discuss with parents how help  their growing child develop and learn and to identify children who are not developing as expected and require additional early intervention to achieve PHE’s goal of being “ready to learn at two and ready for school at five”. This review is at a key time when specific problems may begin to be evident e.g. behaviour problems, speech and language delays. The review considers the health and development of the child alongside the wider environment of home and family.  As part of the review, health visitors will work with parents to complete the Ages and Stages Questionnaire and may be integrated with Early Years settings review.


 Viv Bennett, Chief Nurse, Public Health England


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