Variation in health visiting for the under 5s: A cross-sectional analysis of administrative data in England for 2018-2020

IntroductionThe health visiting service in England leads the delivery of the governments Healthy Child Programme (HCP) for children under five. However, local authorities and their provider partners deliver this service differently in respond to the challenges of funding cuts, low numbers of health visitors and high levels of family needs. ObjectiveWe aimed to describe local authority variation in the delivery of health visiting services to children under 5 in England between 2018 and 2020. MethodsWe used nationally published statistics on mandated health visiting contacts, and administrative data from the Community Services Dataset (CSDS) on duration, location, and medium of delivery of contacts. We mapped the population coverage of mandated contacts (new birth visit, 6-8-week review, one-year review and 2-2 [1/2]year review), and additional contacts, and described the frequency and characteristics of contacts across local authorities. ResultsAccording to the published statistics, 99% of eligible children received their new birth visit, 89% received the 6-8-week review and the one-year review, and 82% received the 2-2[1/2]-year review. There was substantial variation across local authorities: coverage for the 2-2[1/2]-year review ranged between 33%-97%. Based on CSDS, 80% of local authorities (n=46/57) delivered more additional contacts than mandated contacts: on average, 1.6 additional contacts (range: 0.1-8.5) were delivered for each mandated contact. There was also significant variation in the duration of contacts and the percentage of contacts delivered face-to-face and at home. ConclusionsOur study demonstrates substantial variation in the delivery of health visiting services across England, particularly in the delivery of additional contacts. Further research is needed to explore the extent to which this trend has continued and the reasons for this variation. There is also a need to exploit this data to further explore the impact of these different models of service delivery on family outcomes.