The health visiting service operates on a ‘Universal in Reach – Personalised in Response model with four levels of service: community, universal, targeted and specialist support.
Background and context
The health visiting service operates on a ‘Universal in Reach – Personalised in Response model with four levels of service: community, universal, targeted and specialist support. There are five mandated reviews as described in the Healthy Child Programme 0-5 years:
- Antenatal contact
- New Birth Visit 10-14 days
- 6-8 weeks
- 1 year review
- 2 – 2 ½ year review
The five mandated reviews are not the full extent of health visiting services, as families may require additional contact and support (Health Visiting and school nursing delivery model, 2021).
Identifying the gap
Despite the fact that in B&NES the health visiting service is reaching almost 90% of all reviews at 2 – 2 ½ years and 90% for the 1 year review at 15 months they have found that by the time children are at the end of the Reception year there is a significant drop in a good level of development. The health visitors and senior leaders were concerned about what is happening to children between the ages of 2 and 5 years and how the ‘normal level’ of development has shifted. By the time a child reaches 7 years of age they are seeing rapid increases in demand for mental health and emotional well-being support.
The solution
Over the last few years the health visiting service has been working closely with commissioners to influence the implementation of an additional targeted review at 3 to 3½ years. This has now been agreed and will be starting in April 2026. Initially children with needs identified at the 2-2.5 year review, families living in the most deprived areas as well as children with safeguarding considerations, SEND and other vulnerabilities will be targeted. The detailed pathway is still being developed.
It is anticipated that an additional, targeted development review at 3 to 3.5 years will support the identification of emerging more complex needs, in time to provide support prior to starting school. The health visitors will apply their professional/clinical judgement to identify whether an additional contact at 3 to 3 ½ years would enable the service to identify and take steps to meet any unmet needs. This additional contact will be in partnership with parents to enable additional support to be targeted as early as possible to ensure children are ready for school at 5 years.