Must knows for elected members: The Healthy Child programme

Every child deserves the best start in life and councils play a vital role in making that happen."

The Healthy Child programme is the cornerstone of England’s universal public health nursing offer for babies, children and young people. It is delivered by health visitors (for children aged 0–5) and school nurses (for children and young people aged 5–19, or up to 25 for care leavers and those with special educational needs and disabilities).

While it provides an essential foundation for prevention and early intervention, councils deliver it within significant financial and workforce constraints. Rising demand, complex family needs and limited resources make sustaining high-quality delivery challenging.

The programme is not just a set of checks. It is a whole‑system approach to prevention and early intervention, combining:

• five mandated health and development reviews in the early years
• four recommended reviews during school age
• proportionate support at community, universal, targeted and specialist levels.

These contacts and interventions identify need and risk early, narrow inequalities, and support children to be healthy, develop well and be ready to learn.

For councillors, understanding the Healthy Child programme matters because it underpins local ambitions on early years and child development, prevention and early intervention, safeguarding and reducing health inequalities.

The programme also aligns closely with the Government’s Best Start in Life (BSiL) vision, which many elected members are already familiar with, reinforcing shared ambitions around early childhood development and prevention and the '10-Year Health Plan for England, Fit for the Future' focussed on neighbourhood health which aims to deliver the benefits of closer working relationships between professionals and convenience of access to a range of clinical services will support families.

Guidance, refreshed by the Department of Health and Social Care (DHSC) sets out what good looks like, including:

• face-to-face, relationship-based practice, supported by improved digital tools designed to complement, not replace, personal contact
• five mandated reviews, offered on time
• skilled assessment by a Specialist Community Public Health Nurse (SCPHN)
• targeted and specialist support for families with greater need
• appropriate contribution to multi‑agency safeguarding and data‑informed improvement
• safe, equitable and responsive care – care that reflects the diversity of children and families, adapts to evolving needs, and remains rooted in evidence, compassion and community.

• A universal, statutory prevention and early intervention service commissioned by upper tier local authorities to deliver against their responsibility to improve the health of the local population within the Health and Social Care Act 2012 (amended 2022).
• This is a mandated duty of the Director of Public Health.
• The only universal service that sees and supports all families from pregnancy through to late adolescence.
• Delivered through health visiting (age 0–5) and school nursing services for age 5–19/25 (depending on local commissioning arrangements); some areas include Family Nurse Partnership (intensive home-visiting support for young parents).
• Delivered in the home and in the local community including within education settings.
• Addresses physical and emotional wellbeing, childhood development, support to parents, early identification of children and families in need (with referrals to specialist services where appropriate), safeguarding, and reducing inequalities, following a clear framework of high‑impact areas.
• A major public health investment with long‑term system impacts enabling babies and children to have the best start in life.
• Councillors play a key role in assurance, scrutiny and leadership.

The Healthy Child programme is the national model for public health nursing for children and young people. It brings together screening, health protection, child development and health promotion through regular contact with families.

Children and young people make up a significant proportion of the UK population, with those under 25 accounting for 29.1 per cent of the population in England and Wales (2021 Census). Demand for health and social care services for this group is increasing.

This includes greater need for support in the first 1,001 days and early years, mental health care and community services that promote healthy lifestyles. However, access to timely care is often constrained by service capacity and funding pressures.

When the programme is delivered well, it helps prevent avoidable problems from escalating, reducing pressure on health, education and children’s social care services later on.

The cost of inaction is significant. When opportunities for early identification and support are missed, preventable issues are more likely to escalate. Developmental delay, safeguarding risk and health inequalities become harder and more expensive to address, increasing pressure on hospitals, specialist services and children’s social care. Poor outcomes in the early years can have lasting consequences for mental and physical health, education and employment, reinforcing cycles of disadvantage and higher long‑term public spending.

Local authorities and directors of public health are committed to delivering the Healthy Child programme, but face ongoing workforce challenges. Between 2015 and 2022, the health visiting workforce fell by nearly 40 per cent, while school nursing nationally has seen a 33 per cent reduction in the workforce since 2009.

This national figure masks significant local variation: in some areas, school nursing is no longer commissioned. These reductions in the workforce – linked to public health grant pressures, fewer training places, and staff turnover or retirement – continue to affect local capacity and make sustaining delivery and quality an ongoing priority.

Councils are responsible for improving the health of children and young people in their area and for commissioning the Healthy Child programme as part of their public health duties.

The programme is universal and statutory, meaning councils remain accountable for ensuring it is delivered safely, lawfully and in line with national requirements, regardless of who provides the service locally. Services are commissioned under the NHS Act 2006 and delivered in line with the Local Authorities (Public Health Functions) Regulations 2013.

Commissioners are responsible for assuring service quality, safeguarding, equality, workforce capacity, value for public money and the effective use of data, supported by mandatory performance reporting to NHS England through the Community Services Data Set.

For elected members, this reinforces the Healthy Child programme as a core local government responsibility within the public health system.

The Healthy Child programme is a significant element of local government public health investment.

In 2025/26, councils in England are expected to invest, through the public health grant, around:

• £941 million in children’s public health services for children aged 0 to five
• £303 million for children and young people aged five to 19.

(alongside other preventative and support services such as smoking cessation, drug and alcohol treatment, domestic abuse, sexual health and obesity prevention).

Through the Healthy Child programme, councils support:

• every new birth cohort, through the five statutory health and development reviews within the first 1,001 days with additional targeted and specialist support as required and a community level of service universally available to all families
• millions of school‑aged children and young people, through school nursing services at community, universal, targeted and specialist levels (whether or not children are attending schools).

In 2024/25, health visiting services in England delivered over half a million new birth visits, reaching around 98 per cent of babies.

This makes the Healthy Child programme one of the widest-reaching universal services commissioned by councils, with a key focus on robust health assessment, early identification of need, prevention and early intervention, alongside its important role in safeguarding.

Each year, the council’s chief executive (or finance director) and director of public health must formally confirm that the public health grant has been spent in line with grant conditions, with the Department of Health and Social Care undertaking assurance activity to confirm appropriate use of funding.

Local authorities commission the Healthy Child programme and have flexibility in how services are delivered locally.

Councils may commission Healthy Child programme services from:

• NHS organisations, such as NHS Trusts or Foundation Trusts
• voluntary and community sector organisations
• private or independent providers.

Some councils also directly employ health visitors and school nurses 'in-house'.

Organisations that deliver the Healthy Child programme must be registered with the Care Quality Commission (CQC) for the delivery of regulated activities.

Regardless of the provider, councils remain responsible for ensuring that services meet statutory requirements, are appropriately governed, and deliver safe, high‑quality and equitable support for children, young people and families.

Delivery arrangements vary locally, but the core elements of the Healthy Child programme – including universal reach (ensuring equitable access by population groups less likely to engage in support), delivery of mandated service elements, safeguarding responsibilities and clinical leadership – must be maintained.

The Healthy Child programme is delivered by public health nursing teams, led by health visitors and school nurses. Where services include Family Nurse Partnership, these teams are led by family nurses. These are all registered nurses or midwives with additional specialist training in public health nursing and regulatory oversight by the Nursing and Midwifery Council.

Health visitors and school nurses may be employed by NHS organisations, voluntary sector or independent providers, and in some areas directly by the council but they remain registered professionals accountable to the Nursing and Midwifery Council and required to fulfil regular revalidation requirements.

In practice:

• health visitors lead services for babies, pre‑school children and their families (ages 0–5)
• school nurses lead services for children and young people of school age (5–19, or up to 25 for care leavers and young people with SEND).

Health visitors and school nurses hold professional accountability for:

• assessing children’s health and development
• early identification of vulnerability and safeguarding concerns
• planning and coordinating support
• supervising and overseeing delegated work within their teams.

While they work alongside wider teams – for example staff nurses, nursing associates or nursery nurses - health visitors and school nurses retain overall responsibility for the quality and safety of practice. This professional leadership is a vital safeguard within a universal service and underpins the programme’s role in prevention, early intervention and reducing inequalities.

Effective delivery depends on well‑structured skill‑mix models. When tasks are appropriately delegated and supported, wider team members can:

• build trusted relationships with children, young people and families
• provide timely, practical support and continuity of contact
• improve access in communities with higher levels of need.

Health visiting and school nursing teams work in partnership with a wide range of local services, including maternity, family hubs, schools, early years provision, children’s social care and the voluntary sector, to deliver integrated, preventative support that responds to local need and improves outcomes for children, young people and families.

Under the Healthy Child programme, councils must provide five universal health and development reviews for all eligible families:

• antenatal – from 28 weeks of pregnancy onwards
• new birth – from one day to two weeks old
• six to eight weeks old
• 12 months – nine to 15 months old
• two to two and a half years – 24 to 30 months old.

Best practice is for a health visitor to deliver the antenatal, new birth, and six to eight week reviews face-to-face in the home. This approach maximises child visibility, enables contextual assessment, and supports safeguarding. Other reviews can be delivered flexibly, such as in clinics or Best Start Family Hubs, based on family needs rather than service convenience.

Each review should be holistic and relationship-based, led by a specialist community public health nurse (with clearly governed delegation where permitted and appropriately risk assessed), and use validated developmental tools to inform, not replace, professional judgment.

School nursing teams provide a universal and proportionate service, including four recommended health reviews at key stages: Reception, Year 6, Year 8, and Year 10. These reviews help identify health needs early, support prevention, and enable timely intervention.

School nurses work in close partnership with schools, children’s services, primary care, and wider agencies (for example mental health support teams), offering accessible support through channels such as drop-in sessions and secure messaging platforms like ChatHealth – designed to meet young people’s preferences. The school nursing programme delivers the National Child Measurement Programme. The service also works alongside the School Aged Immunisation Service. You can read more about the role of a school nurse.

How support is tailored: the four levels

The Healthy Child programme is delivered through a tiered approach.

• Community: Population-level health promotion and protection, campaigns, and building community assets.
• Universal: The core offer for all children and families, including statutory reviews, advice, and health promotion.
• Targeted: Selective (proactive support for vulnerable groups) and indicated (additional help for specific concerns such as mild developmental delay, parental mental health issues, or social isolation).
• Specialist: Intensive, multi-agency input for complex needs, safeguarding, SEND, or trauma.

This tiered model puts proportionate universalism into practice, ensuring equitable access and improved outcomes while focusing resources where they will have the greatest impact.

The Healthy Child programme is delivered through strong multi-agency collaboration, bringing together maternity services, primary care, early years providers, schools, children’s services, public health, family hubs and the voluntary sector to provide universal and proportionate support.

The Healthy Child programme plays a core role within a wide range of health and care pathways and this multi-agency approach ensures children and families are supported into the right level of support at the right time.

Continuity of care is critical, particularly for families who move frequently, cross local authority boundaries, or live in temporary accommodation. Effective handover protocols and timely contact help maintain safety and support early identification of needs.

Services can be provided flexibly across homes, clinics, Best Start family hubs, schools and youth settings, tailored to family context and need. Co-location of teams and strong communication between agencies (for example housing, primary care, maternity services) can enhance joint working and improve the experience for families.

When notified of a family transferring into the area with at least one child under five, the health visiting service should respond within five days and make contact within 10 working days to arrange a home visit as soon as possible. For families in temporary accommodation - where risks are higher, especially for babies under one – the visit should be prioritised.

During transfer-in visits, health visitors complete a comprehensive health needs assessment, including:

• checking the child’s developmental progress
• reviewing immunisation status and advising on catch-up if needed
• confirming GP registration and signposting if not registered
• providing information on local services, support groups and community resources
• explaining the statutory offer and how to access support between scheduled contacts.

This approach ensures continuity of care, supports early identification of needs, and helps families settle into the area with access to appropriate services.

The refreshed Healthy Child programme sits within a wider programme of national reform across health and children’s services. Several developments are particularly relevant for councillors to note.

Neighbourhood health services

The Government’s Fit for the Future: 10 Year Health Plan for England signals a major shift from hospital‑based care to neighbourhood and community‑based models, with care delivered closer to where people live. This is predominantly focused on the adult population with the aim to strengthen prevention approaches, improve access and reduce pressure on acute services. It creates opportunities to better align the place-based working of health visiting and school nursing teams and Best Start Family Hubs and early help services.

Digital child health records

The 10 Year Health Plan also commits to greater use of digital tools, including a digital child health record ('digital red book') within the NHS App. For families, this will aim to improve access to information and continuity of care. For local services, digital developments are intended to support, not replace, face‑to‑face public health nursing.

National progress on a digital Personal Child Health Record, or digital red book, has been slow. In the absence of a fully implemented national model, some local areas have developed their own interim digital tools to support families and improve access to information. These local developments may offer learning as national improvements continue.

Improving childhood immunisation uptake

New approaches are being tested nationally to improve childhood immunisation uptake, including delivering vaccines during health visits for families who face barriers to accessing GP services.

Councils have a statutory duty to promote uptake in line with national guidance, while respecting parental choice and addressing barriers to access. Health visitors and school nurses already play a key role in promoting immunisation and addressing hesitancy.

To support this, the Government recently launched a £2 million pilot enabling health visitors to deliver vaccinations during routine home visits. The pilot targets families facing barriers such as travel costs, language difficulties, or vaccine hesitancy, aiming to 'bring vaccines to the doorsteps' of those most at risk of missing out. Twelve schemes are being rolled out across five regions from mid-January and will be evaluated before potential national rollout in 2027.

Any future changes will require close partnership working between councils, NHS commissioners and providers, with a continued focus on reaching underserved communities.

Children’s Wellbeing and Schools Bill

The Children’s Wellbeing and Schools Bill, currently progressing through Parliament, proposes reforms to strengthen safeguarding and information‑sharing. These include:

• piloting a single unique identifier for children
• establishing multi‑agency child protection teams with stronger health, education and social care involvement.

If enacted, these changes are expected to increase the importance of the Healthy Child Programme in its role as a universal, early‑identification service, and will require strong local leadership to ensure new arrangements support prevention as well as statutory safeguarding.

What this means for councillors

These developments reinforce the Healthy Child programme as a core prevention service within a changing system. For elected members, future‑proofing the Healthy Child programme means ensuring that:

• it is well integrated into neighbourhood and place‑based approaches
• digital change improves access without widening inequalities
• specialist public health nursing leadership is protected
• safeguarding reforms strengthen, rather than fragment, prevention and early intervention.

Local leadership will be critical to translating national reform into better outcomes for children, young people and families.

Councillors are encouraged to work with their director of public health to understand how the Healthy Child Programme operates locally and to support effective oversight of quality, capacity and sustainability.

What follows describes an ambition for effective delivery, recognising that local models will vary:

• universal reach, with strong delivery of the five statutory early years reviews, equitable access across communities, and clear routes into targeted and specialist support
• visible professional leadership, with early contacts led by health visitors, safe delegation and robust supervision arrangements
• inclusive services, shaped by families’ experiences and designed to reduce barriers related to language, literacy, digital access and inequality
• joined‑up working, with effective integration across maternity, primary care, early years, schools, family hubs and children’s services
• strong safeguarding assurance, consistent with national guidance and supported by clear roles, accountability and multi‑agency working
• meaningful use of data, to understand impact and inequalities and to drive quality improvement, not just to report activity
• a sustainable workforce, with credible plans for recruitment, training, retention and professional development.

1. What Healthy Child programme services are available locally for babies, children and young people, and how are statutory health and development reviews delivered?
2. How is population-level data – together with insight on what this means for outcomes for children and families - being used to inform improvements (for example, what happens after a child is weighed or assessed)?
3. How is information from the Healthy Child programme being reported through appropriate governance routes (such as the Health and Wellbeing Board or scrutiny) to inform strategic decisions?
4. What multiagency approaches are in place to deliver the Healthy Child programme, including partnership working with maternity, early years, schools, family hubs and children’s social care?
5. How effective are these arrangements in supporting joined‑up pathways for families?
6. How do you know that the Healthy Child programme is reaching all children and families, particularly those facing disadvantage or additional barriers, and that safeguarding risks, child developmental delays and health needs are identified early?
7. What plans are in place to address workforce and resource challenges that may impact the sustainability and quality of the Healthy Child programme locally?

1. Are the health and wellbeing needs of children reflected as a priority in the joint Health and Wellbeing strategy?
2. Is the Health and Wellbeing Board or Health Overview and Scrutiny Committee receiving regular, proportionate assurance on performance, inequalities and outcomes for the Healthy Child programme, and using this to hold the system to account?

Government documents:

• Healthy child programme - GOV.UK (February 2026)
• Child and Maternal Health | Fingertips | Department of Health and Social Care
• Health visitor service delivery metrics: data for 2025 to 2026 
• Child health - Office for National Statistics

Local Government Association publications