On Friday 15 December, the Department for Education (DfE) published its updated version of “Working Together to Safeguard Children 2023”. The Department consulted with key stakeholders on proposed changes through an open consultation process between June and September this year.

To support the consultation, the Institute of Health Visiting engaged in meetings with DfE officials and submitted a written submission to the consultation in September 2023. Our considered position was developed in partnership with frontline practitioners, service leads, safeguarding representatives and our iHV Expert Advisers for Safeguarding, and through an iHV Roundtable event in August 2023 – you can read our written response to the consultation here.

“Working Together to Safeguard Children 2023” focuses on strengthening multi-agency working. It brings together new and existing guidance to emphasise that successful outcomes for children depend on strong multi-agency partnership working across the whole system of help, support and protection including effective work from all agencies with parents, carers, and families. We support this position – safeguarding is everyone’s business. There is a clear imperative to strengthen services to ensure that the most vulnerable babies, children and young people in our society are supported to achieve their full potential and are protected from harm.

This statutory guidance sets out key roles for individuals, organisations and agencies to deliver effective arrangements. It covers the legislative requirements, a framework for the three local safeguarding partners (local authorities, Integrated Care Boards and police), and a framework for child death reviews.  This revision has a renewed focus on how organisations and agencies provide:

  • Early help
  • Safeguarding and promoting the welfare of children
  • Child protection.

Of relevance to health visiting, the guidance introduces changes to the lead practitioner role. It clarifies that a broader range of practitioner can be the lead practitioner for children and families receiving support and services under section 17 of the Children Act 1989 (Child in Need), and the requirements on local authorities and their partners to agree and set out local governance arrangements.
The guidance states:

“Once the referral has been accepted by local authority children’s social care, a social work qualified practice supervisor or manager should decide, with partners where appropriate, who the most appropriate lead practitioner will be and, with the lead practitioner’s agreement, allocate them in line with the local protocol.

The lead practitioner role can be held by a range of people, including social workers. When allocating the lead practitioner, local authorities and their partners should consider the needs of the child and their family to ensure the lead practitioner has the time required to undertake the role. The lead practitioner should have the skills, knowledge, competence, and experience to work effectively with the child and their family. The lead practitioner should always be a social worker for child protection enquiries.”

Our response to the Working Together consultation sets out our position on this. To ensure that the key preventative public health role of health visitors is not compromised, we strongly recommend that implementation and prioritisation decisions take account of the full breadth of the Health Visiting Model for England, and support delivery of the Healthy Child Programme in full. Health visitors deliver important ‘health’ functions within a whole system approach that cannot be overlooked. These support clinical pathways across the NHS (urgent, primary and secondary care) and education (child development, school readiness and Special Education Needs and Disabilities (SEND)), alongside child safeguarding. For example, supporting parents to manage minor illnesses (read our latest evidence review on the crisis in urgent care for children 0-4years), providing interventions for families affected by perinatal mental illness and a range of physical needs in the postnatal care pathway, reducing risk factors for preventable disease (addressing smoking, poor nutrition, alcohol risks and physical inactivity) and early identification and support for children with developmental delay and SEND.

We recognise that there may be occasions when having a health visitor as the lead practitioner might be in the best interest of the child and we set these out in our consultation response – in summary:

  • We do not support the case that health visitors should be the default lead practitioner for all babies and young children categorised as “Child in Need”.
  • Designation of the lead practitioner needs to be agreed on a case-by-case basis, in the best interests of the child, and only when the health visiting service is sufficiently resourced (not as a sticking plaster for an under-resourced children’s social care department). For example, when a family is being supported through a preventative public health, health visitor-led, intensive home visiting programme like the Family Nurse Partnership Programme or the Maternal Early Childhood Sustained Home-visiting (MECSH) programme, or through a targeted programme of health visiting support for a child with Special Education Needs and Disabilities (SEND).
  • However, care needs to be taken as there is a significant risk that, without sufficient resource, focusing health visitors’ efforts on statutory Child in Need cases will further accelerate their role drift away from preventative public health and earlier intervention (this was flagged as a national risk in our “State of Health Visiting” survey, published in 2023). Health visitors’ important “upstream” role is focused primarily on preventing, identifying and working with families to address problems before they reach crisis point. This takes pressure off children’s social care and is less costly in the long run. Health visiting is the only agency that proactively and systematically reaches out to all families with babies and young children from pregnancy and through the earliest years of life – this is a safety-critical function that needs to be protected at all costs. Without sufficient resource, eroding this “safety-net” further strips out the mechanism to identify vulnerable babies and young children.

The “Working Together to Safeguard Children 2023” guidance also includes:

  • New national multi-agency child protection standards which set out actions, considerations and behaviours for improved child protection practice and outcomes for children.
  • Clarification of roles and responsibilities of health practitioners, with specific duties for child safeguarding.
  • Domestic Abuse Act 2021 legislation and the National Framework statutory guidance that supports a child-centred approach.
  • Updated guidance and terminology on the management of child deaths and the language around the responsibility of professionals where relevant, to inform relevant safeguarding partners and the Child Safeguarding Practice Review Panel.
  • Guidance on Improving practice with children, young people and families which provides advice for local areas to embed working together to safeguard children and the children’s social care national framework in practice.


The Department for Education (DfE) has announced that it is investing more than £7 million, over the next 2 years to support local areas. This consists of £6.48 million grant funding in January 2024, for safeguarding partners to:

  • Make changes to multi-agency safeguarding arrangements in light of the revised Working Together to Safeguard Children statutory guidance.
  • Build a shared understanding between agencies of what the national framework means for multi-agency working.

This funding does not cover the costs of service delivery and sustainability. The guidance sets out an expectation that “leaders are ambitious about helping, supporting, and protecting children in their area and jointly prioritise and share resources accordingly”. If fully implemented, it is clear that these changes will place additional burdens on the health visiting workforce, shifting responsibilities from children’s social care to other services.

We are concerned that, as the costs of child protection continue to soar, budgets will not be redistributed to offset the additional burdens that this guidance places on organisations taking on the lead practitioner responsibilities. Prioritisation is likely to favour statutory responsibilities. Without addressing funding and health visiting workforce issues, services will be pressurised to prioritise “Child in Need” cases at the expense of preventative public health, leaving more families without the support that they need in other areas and proving much more costly in the long run.

This guidance presents an important opportunity to improve the care, support and safety of babies, children and young people. Its success will depend on its implementation as part of a whole system approach that also includes prevention and early intervention. As this directive represents a new national policy, we strongly recommend that its implementation is subject to the scrutiny of the Office for Budget Responsibility to ensure that it is fully costed and any additional burdens placed on services are managed with a commensurate budget uplift, workforce planning and action to address the current postcode lottery of health visiting service provision.

Next steps:

NHS Safeguarding is developing a safeguarding workplan to support the implementation of this guidance (we understand that the draft plan is due in mid-January 2024). At the iHV, we will be working closely with officials in the Office for Health Improvement and Disparities, NHS Safeguarding, and partners in other professional bodies and organisations including the School and Public Health Nurses Association, Association of Directors of Public Health and Local Government Association, to consider the specific implications of the Working Together 2023 guidance for health visiting and to support its implementation in practice.

The full suite of Working Together 2023 documents is available here:

This week has seen a raft of policy publications from the Department of Health and Social Care. Read our quick update and signposting to resources:

The  Health and Care Act 2022 has introduced new architecture to the health and care system, with England formally divided into 42 area-based Integrated Care Systems, covering populations of around 500,000 to 3 million people. Integrated Care Systems are partnerships of health and care organisations that come together to plan and deliver joined up services, with the aim of improving health and reducing inequalities for people who live and work in their area.

Specifically this will lead to the establishment of Integrated Care Boards (ICBs) and Integrated Care Partnerships (ICPs). Previously, Health and wellbeing boards (HWBs) have been a key mechanism for driving joined-up working at a local level since they were established in 2013.

In this new landscape, HWBs continue to play an important role in:

  • instilling mechanisms for joint working across health and care organisations
  • setting strategic direction to improve the health and wellbeing of people locally

The Department for Health and Social Care (DHSC) will therefore be updating the guidance on the HWBs general duties and powers to provide information on how HWBs currently work and clarify their role within the system – including working with ICBs and ICPs.

There is a significant step forward in national policy (in which iHV had an input) to see that the usual reference to children and young people, now includes the addition of ‘babies’ in their own right – this guidance marks a key step in ensuring that babies, children, young people and families will be prioritised in the new Integrated Care Systems. Amongst other provisions, the guidance sets out that engagement on strategies should be inclusive of children, young people and their families, including new and expectant parents. There is also an explicit section on how babies, children, young people, and families should be considered in the content of the strategies.

New Guidance

  • Health and wellbeing boards: draft guidance for engagement
    This draft guidance for engagement sets out the role of health and wellbeing boards following publication of the Health and Care Act 2022.
  • Guidance on the preparation of integrated care strategies
    This is statutory guidance for integrated care partnerships on the preparation of integrated care strategies. This document contains an introduction, 2 sections of statutory guidance on the preparation of the integrated care strategy including involvement and content, and a section of non-statutory guidance relating to the publication and review of the integrated care strategy.
  • Health overview and scrutiny committee principles
    This guidance sets out the expectations on how health overview and scrutiny committees should work with integrated care systems (ICSs) to ensure they are locally accountable to their communities.

In March 2022, The National Institute for Health and Care Excellence (NICE) published a new comprehensive quality standard designed to improve the diagnosis and assessment of foetal alcohol spectrum disorder (FASD). The NICE guidance says midwives and other healthcare professionals (including health visitors) should give clear and consistent advice on avoiding alcohol throughout pregnancy, and explain the benefits of this, including preventing FASD and reducing the risks of low birth weight, preterm birth and the baby being small for gestational age.

The NICE quality standard highlights five key areas for improvement:

  • Pregnant women are given advice throughout pregnancy not to drink alcohol.
  • Pregnant women are asked about their alcohol use throughout their pregnancy, and this is recorded.
  • Children and young people with probable prenatal alcohol exposure and significant physical, developmental, or behavioural difficulties are referred for assessment.
  • Children and young people with confirmed prenatal alcohol exposure or all 3 facial features associated with prenatal alcohol exposure have a neurodevelopmental assessment if there are clinical concerns.
  • Children and young people with a diagnosis of FASD have a management plan to address their needs.

Updated GPPs

As a result, we have updated two Good Practice Points (GPPs) which now include links to the recently published NICE guidance:

Please note that GPPs are available to iHV members only.

If you’re not a member, please join us to get access to all of our resources.

The iHV is a self-funding charity – we can only be successful in our mission to strengthen health visiting practice if the health visiting profession and its supporters join us on our journey. We rely on our membership to develop new resources for our members.

So do join us now!

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iHV welcomes yesterday’s publication of PHE guidance on Care continuity between midwifery and health visiting services: principles for practice.

The PHE guidance document is designed to act as a tool to support local practice implementation and improvements in the care continuity between midwifery and health visiting services. It was developed based on a literature search of current research, an examination of current UK guidance and policy and interviewing midwives and health visitors working in Local Maternity Systems. The document provides evidence and practice examples to consider when improving quality of care through effective transition of information and collaborative practice between midwifery and health visiting services.

Alison Morton, Executive Director at the Institute of Health Visiting, commented:

“We support and welcome this new guidance from Public Health England on the care continuity between midwifery and health visiting.

“We know from our iHV annual surveys that continuity of care and building trusting relationships with parents is critical for delivering good support in the first 1001 days. Improving the quality of care for parents and their babies throughout their maternity journey, through the effective sharing of information and collaborative practice between midwifery and health visiting services, will help ensure that consistent and evidence-based information is given. Continuity of care, as well as continuity of carer (they are not the same thing), between midwifery and health visiting is crucial to ensure that health visitors provide safe and personalised care – tailored to each family’s individual needs.”

Clare Livingstone, Professional Policy Advisor at the Royal College of Midwives, said:

“This will be a valuable resource for midwives and health visitors in facilitating women to have the smoothest possible journey throughout and beyond their pregnancy. The point at which women’s care is transferred from midwives to health visitors, at around 10-14 days after the birth, is a critical point in that journey. This toolkit will support a better and more efficient handover of care, joining up the two services and ensuring care continuity for women and their babies.”

Following the Prime Minister’s announcement last night of more stringent guidance to “Stay at Home”, we know that many of you will be asking questions about how this impacts your families and the important services that you provide. This is also a worrying time for families who may be wanting to access helpful parenting information. The Institute is doing all we can to support the government-led decisions (nationally and locally) by disseminating any guidance as soon as it is published to avoid confusion and mixed messages at this time when clarity is needed.

We have a dedicated COVID-19 section of our website which we are using to provide updates as and when they are received.

Our colleagues at Public Health England and local government are moving at extraordinary pace and scale at this time – we thank and applaud them for all their efforts during the unfolding events of this pandemic.

Following the PM’s announcement last night, the latest advice has been received:

Outline details of priority work is set out in the NHS COVID-19 Prioritisation within Community Health Services published last Friday.  The NHS are currently developing a more detailed Standard Operating Procedure (SOP) that will be published soon – the NHS are custodians of the SOP as this avoids confusion, retaining a single line of communication.  It is high level covering all community services (under NHS standard contract). PHE expect that common approach will be applied across all services.

PHE are aware that families understandably do not want home visits so it makes sense to prepare advice ahead of the SOP being published.

Viv Bennett, the Chief Nurse at PHE, has given us the following holding advice: “I think that what is clear is that the presumption should be that contacts will be virtual – skype, facetime and failing that phone call.  There will need to be individual assessment of compelling need for face to face contacts and then decisions re PPE”.

The iHV will be supporting this work by developing guidance for health visitors to address questions like, “What makes an effective virtual visit especially for AN breastfeeding support and NBV”.

We share some of the latest Government guidance on our website – both for families and healthcare professionals:

This information is being regularly reviewed and updated.  We will be adding more content regarding supportive resources for parents and carers in the coming days and weeks make this a repository of best advice for families during these difficult times – so bookmark these pages for any further updates. We have waivered our usual restrictions on resources for members and the COVID-19 sections of our website are “free access” to all to support the national response to this pandemic.

We suggest that you also keep a look out on the government COVID-19 update web pages and contact your local commissioner and Director of Public Health who will be coordinating the response to the NHS guidance in your area.

We have received numerous enquiries from health visitors asking for greater clarity for the health visiting service during the COVID-19 pandemic.  The Institute is doing all we can to expedite this information for the profession and have a dedicated COVID-19 section of our website which we are using to provide updates as and when they are received. However, at the moment the content still lacks this much needed detail for health visitors’ roles.

We have contacted Public Health England, the Local Government Association and the Association of Directors of Public Health to highlight the need for advice to manage the numerous queries that we are receiving from health visitors, including service leads around emergency planning and escalation for the health visiting service – things like, “should we carry on with universal contacts?” “Will I be redeployed? And if so, when?” “What about families who have safeguarding concerns or high levels of vulnerability?” “Am I in a priority key-worker group?” etc…

The latest update that we have received from Public Health England is that the NHS is leading on drafting guidance on community services including health visiting. PHE and local government have provided advice and we are awaiting publication.  We will alert our members and followers when we receive advice that it has been published – hopefully very soon. As there is considerable pressure and pace within the healthcare system due to the pandemic, we suggest that you also keep a look out on the government COVID-19 update web pages and contact your local commissioner and Director of Public Health who will be coordinating the response to the NHS guidance in your area.

Our position at the iHV is that we need to support the government-led decisions (nationally and locally) rather than issuing our own guidance which may cause confusion and mixed messages at this time when clarity is needed.

We will continue to do all that we can to help.

A big thank you to everyone working in health visiting at this time. You are all doing an amazing job during the uncertainties of the COVID-19 situation – it is comforting to know that we have great teams of people who care so much about the communities they work in, and the health and wellbeing of families.

Many parents are very concerned about how to feed their babies during the COVID-19 outbreak.  Here, we share the latest statement on best practice from Unicef UK Baby Friendly Initiative – who also suggest that all practitioners follow latest updates from the UK governments and the World Health Organization (WHO) as these could change as more information becomes available.

The Unicef statement (on the link below) includes:

  • Public Health England (PHE) guidance – If you are breastfeeding while infected
  • Accessing infant formula – information from First Steps Nutrition Trust


In addition, the Royal College of Obstetricians and Gynaecologists (RCOG) has updated their guidance on Coronavirus (COVID-19) infection and pregnancy (published today 18 March) to reflect the announcement on Monday evening (16 March) that pregnant women have been placed in a ‘vulnerable group’. Check the summary of updates on pages 3-5 to see all the changes.

As a result RCOG Information for pregnant women is updated:

The Royal College of Nursing (RCN), alongside over 20 health organisations including the Institute of Health Visiting, has published new safeguarding guidance for healthcare staff responsible for the care and protection of children and young people.

Safeguarding guide

Called ‘Safeguarding Children and Young People: Roles and Competencies for Healthcare Staff’, the document provides clear guidance to healthcare professionals on how to protect children and young people in their care and what to do in the event they come to harm.

All staff who come into contact with children and young people have a responsibility to safeguard and promote their welfare and should know what to do if they have concerns about safeguarding and child protection issues.

The latest document has been updated to include changes to legislation and statutory guidance in England and now includes education and learning logs to enable individuals to record their learning and form a ‘passport’ for those who move on to new jobs or other organisations.