Yesterday afternoon, the long-awaited refreshed commissioning guidance for health visiting and school nursing was published by Public Health England (PHE). This guidance supersedes the previous guidance which was last updated in March 2018.

The guidance is presented in a suite of 3 documents to assist local authorities in the commissioning of health visiting and school nursing services to lead and co-ordinate delivery of public health for children aged 0 to 19.

In PHE’s announcement yesterday, Wendy Nicholson, Deputy Chief Nurse and Deputy Head of the World Health Organization Collaborating Centre for Public Health Nursing and Midwifery at Public Health England stated:

“Setting the foundations for health and wellbeing during pregnancy and in the early years is crucial to ensure we give every child the very best start in life as possible…

We are publishing the revised health visiting and school nursing model, which replaces the “456” model, to focus further on needs assessment so that interventions are personalised to respond to children and families’ needs across time”.

At the iHV, we are still working our way through all the details and their implications on health visiting practice. Important changes and considerations include:

  • The inclusion of two additional universal contacts at 3-4 months and 6 months. These will provide important opportunities to address key public health priorities including, perinatal mental health, child development, breastfeeding, childhood obesity prevention, immunisation uptake and accident prevention.
  • The language of the “4,5,6 model” has been removed; whilst the principles behind the model were sound, there has been widespread agreement that it had inadvertently driven a “race to the bottom” in some areas. The updated document contains welcomed recognition that the health visiting offer is much bigger than 5 mandated contacts, these are just a “gateway” into the service and as PHE highlight, “many areas are offering so much more” – we hope that this will indeed become the norm.
  • An increased emphasis on “personalised” care as well as professional and clinical judgement. This is a helpful reframing of policy which underpins the professional autonomy of the health visitor which is so important if we want to avoid a “one size fits all” approach.
  • Updated language and increased emphasis on health visitors’ contribution to recent policy priorities including, early language development, preconception care and vulnerability.
  • Increased scope for “Emotional Health and Wellbeing Assessments” – alongside maternal mental health, these will now include fathers and babies. In particular, this includes a clear statement that, “Health visitors assess maternal mental health at all health visiting mandated reviews” (NOTE: health visitors, not health visiting; document 2, p.24).
  • We note that in places within the document, there has been a shift in language referring to health visiting, rather than “health visitor”. Will this lead to further erosion of “health visitors” from key elements of the Healthy Child Programme?

We encourage you to read it and tell us your views – we are working our way through the detail.

From what we have read and digested so far, there is a lot in these documents that we welcome. The obvious “elephant in the room” is the lack of details on funding, accountability and essential strategy to address the current workforce issues in health visiting. Let’s hope that these are forthcoming to support the translation of this policy into strategy and the action needed to achieve PHE’s ambition of “No child left behind” – which of course is an ambition that we wholeheartedly share.


Rapid review to update the safeguarding guidance for the Healthy Child Programme for children aged 5 to 19.

The Healthy Child Programme sets out the recommended framework of universal and progressive services for children and young people in England to promote their health and wellbeing.

The purpose of this rapid review is to update the evidence regarding safeguarding guidance, focusing on prevention and early intervention.

The review looks at relevant systematic review level evidence, supplemented with some primary impact evaluations in the areas of preventing or intervening early with:

  • child abuse and neglect
  • child sexual abuse and exploitation
  • intimate partner violence
  • female genital mutilation
  • gang violence

Congratulations to Sussex Community NHS Foundation Trust’s (SCFT) Healthy Child Programme in West Sussex which has received an OUTSTANDING result for Stage 2 Baby Friendly accreditation by UNICEF.

SCFT’s Health Visiting and Infant Feeding Team

SCFT’s Health Visiting and Infant Feeding Team

SCFT’s Health Visiting and Infant Feeding Teams underwent a rigorous assessment process to provide assurance that they deliver the very highest standards of care. SCFT received Stage 1 Baby Friendly accreditation in July 2015 and were “highly commended”.

Stage 2 of the Baby Friendly Initiative assessment assesses the level of knowledge and skills of staff that are providing breastfeeding support and care for pregnant women, mothers and babies.

SCFT is now working towards Stage 3 accreditation. Assessors will interviews mothers across West Sussex to assess if they have been given antenatal and postnatal advice and support by their Health Visiting service as required by UNICEF Baby Friendly. SCFT aims to pass Stage 3 and to be fully accredited as UNICEF Baby Friendly in 2017.

The Department of Health is implementing a new outcome measure of child health at age 2-2½ years, the data for which will be published in the Public Health Outcomes Framework from 2017.

The measure will help monitor child development across England so that we can observe changes in population health from year to year, and potentially also use the data to track children’s outcomes as they grow up. The data will also help to assess the effectiveness and impact of services for 0-2 year olds and support future planning.

Health Visiting providers have been asked to submit data on ASQ-3 scores from October 2015. Department of Health are asking that ASQ:SE data is collected alongside ASQ-3 scores from 1 October 2016.


The National Children’s Bureau (NCB) is pleased to announce the publication of Delivering the Healthy Child Programme for young refugee and migrant children.

The report

This report, based on a scoping study undertaken by NCB, discusses the barriers and enablers refugee and migrant families experience in promoting the health of their young children (from pregnancy to age 5). It explores how local authorities, in shaping their Healthy Child Programme 0-5, are addressing the needs of these young children and their families. The report makes recommendations for how national and local government can promote a healthy start for young refugee and migrant children in England.

This report will be promoted to local public health agencies and voluntary organisations to raise awareness and share examples of practice.

This will be used by our new local authority commissioners. This guidance is for local authorities commissioning ‘public health services for children and young people’ and in particular delivering the Healthy Child Programme 0-5 and 5-19.

The Healthy Child Programme aims to bring together health, education and other main partners to deliver an effective programme for prevention and support.