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

Introduction The health visiting service in England leads the delivery of the government's 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. Objective We aimed to describe local authority variation in the delivery of health visiting services to children under 5 in England between 2018 and 2020. Methods We 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 2-2.5-year review), and additional contacts, and described the frequency and characteristics of contacts across local authorities. Results According 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 2-2.5-year review. There was substantial variation across local authorities: coverage for the 2-2.5-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. Conclusions Our 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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study/project is funded by the NIHR Public Health Research Programme (NIHR129901). This research was supported in part by the NIHR Great Ormond Street Hospital Biomedical Research Centre. This research benefits from and contributes to the NIHR Children and Families Policy Research Unit but was not commissioned through this Policy Research Unit (PR-PRU-1217-21301). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics Committee of University College London Institute of Education (UCL IOE) gave ethical approval for this work (1531). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Access to the CSDS was approved and provided by NHS England (NIC-393510 and NIC-381972). Health Visiting Service Delivery Metrics data are published by the Office for Health Improvement and Disparities and are openly available.