Today, the Department of Health and Social Care published its long-awaited policy blueprint for improving child and family health. The Healthy Child Programme (HCP) is the national framework for improving the health and wellbeing of children and young people aged 0 to 19 (age 25 for care leavers or those living with special educational needs and disabilities) in England.
It sets out evidence-based approaches to prevention, early intervention and family support – supporting the government’s ambition of raising the healthiest ever generation of children.
The updated Healthy Child Programme (HCP) is presented in a suite of resources, including refreshed:
- Delivery guidance which outlines the expected delivery expectations for public health nursing teams for ages 0 to 19 and their provider organisations.
- Commissioning guidance which sets standards for commissioners to establish, monitor and assure the quality of public health nursing services for ages 0 to 19 delivered by provider organisations.
- High-impact area framework which complements these by translating principles into nationally recognised, actionable priorities across ages 0 to 19.
The Department of Health and Social Care has thanked the hundreds of people and organisations (including the Institute of Health Visiting) who contributed feedback for the development of the guidance. Following feedback on the lack of clarity in the previous HCP guidance and wide variation in service equity and quality across England, the purpose of the refreshed guidance is:
- To make the guidance clearer and easier to use for commissioners, providers and practitioners.
- To strengthen assurance around service delivery.
- To ensure the consistency of service quality nationwide.
- To better reflect emerging population health trend and better align with the direction of travel set out in Fit for the future: 10-year health plan and in the context of other government ambitions, including Giving children the best start in life.
Whilst the guidance does not introduce any new statutory duties, it reaffirms the importance of health visitors as a qualified clinical public health workforce and their vital role in healthcare and prevention (from preconception to age 5).
It also maintains the clinical importance of face-to-face contact (where these have drifted in some areas), the importance of high-quality care, and the breadth of health visitor’s role across multiple clinical pathways and ‘high-impact areas’ – while also embedding digital options and supporting research and innovation to ensure services remain proportionate and responsive.
Alison Morton, iHV CEO, provided her initial thoughts on the new guidance:
“We welcome the publication of the updated Healthy Child Programme, which powerfully reaffirms why health visitors are essential and provides a clear, national benchmark for the quality expected in commissioning and delivering services. For too long, families have faced a postcode lottery of health visiting support in the crucial earliest years – a costly mistake in both human and financial terms, leaving too many without support when they needed it most.
“This guidance is an important step forward. By offering long overdue clarity, when fully implemented, it has the potential to transform the quality and consistency of support available to all families. It recognises and enables the full contribution of health visitors, as Specialist Community Public Health Nurses, to help create the healthiest generation of children ever.
“It goes without saying, that this guidance will only be turned into reality with a strong workforce plan to deliver it – and we look forward to seeing this reflected in the forthcoming 10-Year NHS Workforce Plan and supporting its delivery.”
We are still working our way through the details and would value your thoughts on the guidance.
The new HCP focuses on:
- The importance of health visitors (as registered and regulated Specialist Community Public Health Nurses) to lead the delivery of the HCP. This is crucial to ensure quality and safety. The guidance states that every family should be allocated a named health visitor, to support continuity of care and the relationships required for safe and effective practice.
- The importance of home visiting – to enable health visitors to gain a fuller understanding of the family’s living conditions and dynamics, which are central to a robust assessment of health needs. The guidance recognises that certain indicators of risk may not be apparent in clinical or community settings.
- Proportionate levels of service to meet individual needs (all 4 levels of support should be available within every local authority, with service delivery tailored to assessed individual needs):
– Community
– Universal
– Targeted
– Specialist - Clarity on purpose and content of health reviews – and role of the health visitor:
– A minimum of 5 health and development reviews must be offered (with 3 suggested targeted reviews). In line with best practice, the antenatal, new birth and 6-to-8-week health and development reviews should be delivered face to face in the home by a health visitor.
– Other reviews may be offered in alternative settings (including Family Hubs and Neighbourhood health centres) based on family preference and individual circumstances, rather than service convenience.
– Named health visitors should deliver all 5 statutory health and development reviews at specified stages to support continuity of care and relationship building.
– In certain circumstances, a health visitor may delegate a review to a suitably qualified health professional or nursery nurse, provided they are supervised and the health visitor maintains overall accountability. - Clarity on the purpose of health visitors’ targeted and specialist service offer:
– At the targeted level, practitioners deliver additional support based on an assessment identifying specific needs (including a targeted-indicated and targeted-selective offer).
– At the specialist level, practitioners deliver substantial interventions for families requiring intensive or more complex care, based on ongoing assessment. The HCP clearly sets out statutory obligations for specific populations and the crucial role of health visitors in identification, early support and access to services. - Safeguarding: Includes description of the role of health visitors and requirements on local authorities to consider capacity of the health visitor workforce and prioritise delivery of the HCP.
- Collaboration – integration with Family Hubs and Neighbourhood Health Centres: The 10-Year Health Plan commits to the inclusion of health visiting services within Neighbourhood Health Centres, stating ‘health visitors should be system leaders and active partners in neighbourhood teams’. Health services are also a major component of effective Best Start Family Hubs.
- Workforce capacity: The workforce that delivers the HCP – and its numbers, skill mix ratios (and therefore competencies of the different staff) and training commissions – should be based on the current population need. The guidance includes details of provider organisations’ responsibility to ensure that services are delivered by enough appropriate practitioners with the necessary qualifications, skills and experience to carry out the work effectively (including adherence to the NMC Code requirements on scope of competence, delegation, accountability and supervision).
- Workforce and service sustainability: The guidance highlights that delivery of the HCP depends on strategic investment in the qualified SCPHN workforce across both health visiting and school nursing services. Commissioners and provider organisations should ensure there is sufficient SCPHN capacity to lead, deliver and research care safely and effectively for all babies, children, young people and families.
- Workforce development: Clarity on roles and responsibilities, and skills needed to deliver the remit of the HCP and high-impact areas. Clearer supervision, preceptorship and mentoring guidance, alongside continuous professional development to support safe and effective practice and an emphasis on local workforce planning and career development (including recognition of the value of specialist health visitor roles).
- Digital delivery: Improved data sharing, integrated digital records and tailored digital resources; reflect direction set out in the 10-Year Health Plan on digital delivery (whilst ensuring safe and effective practice).
- Quality and implementation: with expectations on a clear approach to monitoring, auditing and benchmarking to secure expected outcomes for babies, children, young people and families – with a focus on purpose and assessment against outcomes. The guidance includes a full list of KPIs for national reporting, and commissioners are also encouraged to introduce their own local KPIs (with examples provided).
- Parental engagement and inclusive practice: Services delivered by 0 to 19 public health nursing teams as part of the HCP should actively engage families from the earliest point of contact, beginning in the antenatal period (including both parents and wider family members where possible). The guidance also highlights the importance of co-production – the design, delivery and review of services should be shaped in response to feedback from children, young people and families.
