Variation in health visiting contacts for children in England: cross-sectional analysis of the 2-2½ year review using administrative data (Community Services Dataset, CSDS)

Caroline Fraser; Katie Harron; Jane Barlow; Samantha Bennett; Geoffrey Woods; Jenny Shand; Sally Kendall; Jenny Woodman

doi:10.1136/bmjopen-2021-053884

Variation in health visiting contacts for children in England: cross-sectional analysis of the 2-2½ year review using administrative data (Community Services Dataset, CSDS)

BMJ Open. 2022 Feb 22;12(2):e053884. doi: 10.1136/bmjopen-2021-053884.

Authors

Caroline Fraser¹, Katie Harron¹, Jane Barlow², Samantha Bennett³, Geoffrey Woods⁴, Jenny Shand^{5

6}, Sally Kendall⁷, Jenny Woodman⁸

Affiliations

¹ Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK, London, UK.
² Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
³ Public Health Division, Operations Directorate, Kent Community Health NHS Foundation Trust, Ashford, UK.
⁴ Early Help Data & Information Team, East Sussex County Council, Lewes, UK.
⁵ UCL Partners, London, UK.
⁶ Care City, London, UK.
⁷ University of Kent, Canterbury, UK.
⁸ Thomas Coram Research Unit, UCL Social Research Institute, London, UK j.woodman@ucl.ac.uk.

Abstract

Objective: The 2-2½ year universal health visiting review in England is a key time point for assessing child development and promoting school readiness. We aimed to ascertain which children were least likely to receive their 2-2½ year review and whether there were additional non-mandated contacts for children who missed this review.

Design, setting, participants: Cross-sectional analysis of the 2-2½ year review and additional health visiting contacts for 181 130 children aged 2 in England 2018/2019, stratified by ethnicity, deprivation, safeguarding vulnerability indicator and Looked After Child status.

Analysis: We used data from 33 local authorities submitting highly complete data on health visiting contacts to the Community Services Dataset. We calculated the percentage of children with a recorded 2-2½ year review and/or any additional health visiting contacts and average number of contacts, by child characteristic.

Results: The most deprived children were slightly less likely to receive a 2-2½ year review than the least deprived children (72% vs 78%) and Looked After Children much less likely, compared with other children (44% vs 69%). When all additional contacts were included, the pattern was reversed (deprivation) or disappeared (Looked After children). A substantial proportion of all children (24%), children with a 'safeguarding vulnerability' (22%) and Looked After children (29%) did not have a record of either a 2-2½ year review or any other face-to-face contact in the year.

Conclusions: A substantial minority of children aged 2 with known vulnerabilities did not see the health visiting team at all in the year. Some higher need children (eg, deprived and Looked After) appeared to be seeing the health visiting team but not receiving their mandated health review. Further work is needed to establish the reasons for this, and potential solutions. There is an urgent need to improve the quality of national health visiting data.

Keywords: child protection; community child health; organisation of health services; public health.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Child
Cross-Sectional Studies
England
Ethnicity*
Humans
Minority Groups*
Social Welfare