Evaluation of the 0-5 Public Health Investment in England: a mixed methods study integrating analyses of national linked administrative data with in-depth case studies

The first five years of life are important for healthy child development. Supporting children and families in these years can help every child reach their potential. Every family in England should see a health visitor five times before a child is three years old, yet the number of times a family sees a health visitor and the types of visits vary across England.

How much difference does health visiting make to a child's health? Does the number of visits matter? Does it matter which member of the team visits the family? This study used information from hospitals, GPs, schools, and social care in local areas, and interviews with parents and professionals to answer these questions. The study helped the government and professionals decide what health visiting services should look like, and fed into government's changes to health visiting and ambition to 'level up' life chances for children.

Between 2016 and 2020, health visiting services reached most families, delivering high volumes of additional contacts. This is vital infrastructure to be built on in two ways. Firstly, by increasing the focus on quality of contacts. This could consider the time it takes to build relationships with families, deliver the planned activities in the mandated contacts, and address new issues that arise. Secondly, by giving weight to additional contacts, so professionals feel they have permission and resources to support families across the full spectrum of need, not only those in crisis.

There is a gap between policy and practice in health visiting. Key performance indicators and some commissioning arrangements may constrain preventive work and deprioritise, or render invisible, additional contacts. These additional contacts represented the majority of activity in many areas and, from the perspectives of parents and professionals, are the way in which health visiting can make a difference. These performance measures and commissioning arrangements should therefore be reviewed.

UCL

University of Kent

Care City London

Institute of Health Visiting