The Institute of Health Visiting welcomes today’s launch of the findings from the Government’s Early Years Review – The Best Start for Life: A Vision for the 1,001 Critical Days.

The Review has been led by Early Years Health Adviser Andrea Leadsom MP and sets out a vision for best practice across the health system for the first 1,001 days of life. We are particularly encouraged by their clear statement of intent that babies and children in England will get a better start in life… with reducing inequalities.

Leading child health experts have provided evidence to the Review team (including members of the team at the Institute of Health Visiting, as well as health visitors in practice). Overwhelmingly, the evidence is clear that the care given during the first 1001 critical days has more influence on a child’s future than at any other time in their life.

Rt Hon Andrea Leadsom MP

The Chairman of the Early Years Healthy Development Review, Rt Hon Andrea Leadsom MP, said:

“When we started work on the Review, I was clear that the needs of the baby must be at the heart of everything we do. The coronavirus pandemic has put even more pressure on already struggling families and, just as we need to level up economic opportunity across the country, we need to level up the support and care for the very youngest.

“The 6 Action Areas will have a transformational impact on our society, and I am looking forward to the implementation phase of the Review where we will continue to work closely with families and the early years sector.  I am confident that delivering this Vision will help millions of families to give their baby the very best start for life.”

The review highlights six action areas which are key to improving health outcomes in babies and young children:

  • Seamless support for families: Local authorities will be encouraged to publish a clear Start for Life offer for parents in their area – a single publication making parents and carers aware of what support they can expect in their local area, including services they should expect to receive like health visits, and localised and specialist services, such as help to quit smoking and intensive parenting support.
  • A welcoming hub for families: This builds on the Government’s commitment to champion Family Hubs, making them a place for families to access Start for Life services, such as childcare, early education and healthcare, as well as advice on jobs and training.
  • The information families need when they need it: Designing digital, virtual and telephone services around the needs of the family, including digitising the Personal Child Health Record, commonly known as the ‘Red Book’. This will apply to every new birth from April 2023, bringing it forward a year.
  • An empowered Start for Life workforce: Developing a modern skilled workforce to meet the changing needs of families with babies. There will also be work to attract people into health visiting and ensure that health visitors are developed and supported.
  • Continually improving the Start for Life offer: Health services for families and babies must improve data, evaluation, and outcomes to ensure it is meeting a family’s needs. Work will continue across the system to hold local services to account, including through proportionate inspections, giving parents and carers confidence and assurance services are working in their area.
  • Leadership for change: Work will begin to encourage local areas to nominate a leader and to ensure the delivery of the review is overseen at a national level.

Dr Cheryll Adams CBE, Founding Director iHV, commented:

“I am thrilled to see the launch of this very timely and important Review, and have been honoured to be an advisor to it.  Implementation of the Review’s Action Areas will offer every family greatly improved access to a range of sources of support, as and when they need them.  By being baby centric, it will also help to ensure that every baby can have access to the Best Start for Life.”

Alison Morton, Acting Executive Director  iHV, said:

“I welcome the clear commitment within this review to reduce inequalities and ensure that every baby achieves their full potential – this is an ambition shared by health visitors and lies at the core of our profession. I thank Andrea Leadsom MP and her team for setting out this important first step that provides a solid foundation on which to build the strategy and plan, with much-needed investment, that will be required to turn these ambitions into a reality. There is no time to waste, against a backdrop of increasing vulnerability facing many families, I look forward to working with the Review Team on the implementation phase.”


Dr Cheryll Adams CBE has written to the Prime Minister, Boris Johnson MP,  to ask him to start to strengthen the health visiting profession now so that it can play its part to help all UK children to be given the opportunity to have the very best start in life.  The Institute is particularly concerned by the growing rates of poverty and widening of health inequalities in the UK, both pre and during the COVID-19 pandemic, and their impact on babies, all children and their parents. This has happened alongside a significant loss of health visitors and development of unwarranted variation in the service across the UK over the past five years.

In the letter to the Prime Minister, the Institute is calling for a national strategy to start to rebuild the health visiting service now, so that it will be able to respond to a range of problems that are expected to be found when families come out of lockdown.  These include missed developmental delays, maternal and paternal mental illness, and growing levels of reported domestic violence. Science has shown that, if not recognised promptly, all can have a significant impact on an infant’s growth and development and their functioning in the future.

Dr Adams has offered the Institute’s recently published Vision document as a framework for new developments for health visiting alongside their expertise.

The Institute of Health Visiting (iHV) is delighted to publish ‘Health visiting – Good practice case studies’ to support our recently issued ‘Health Visiting in England: A Vision for the Future’ – our evidence-based blueprint to rebuild health visiting services.

This resource of ten shortlisted good practice case studies is just a small representation of the great work that health visitors are doing throughout the country – they showcase high quality care in a number of different settings, demonstrating the “art of the possible”.

Giving every child the best start in life remains a key government priority and this document is intended to help spread good practice by learning from those who are leading the way, often in difficult circumstances.


Alison Morton, Director of Policy and Quality at the Institute of Health Visiting, commented:

“As we start the International Year of the Nurse and the Midwife, in honour of Florence Nightingale, a pioneer for public health and founder of modern nursing, it is timely to publish ‘good news stories’ about health visiting – to shine a light on the vital contribution that health visitors, as part of the nursing workforce, play in improving outcomes for children and their families.”

Collated in response to Public Health England’s call for submissions to support the refresh of the Healthy Child Programme and the 4-5-6 model, these good practice case studies represent a range of public health priorities, as well as initiatives to improve analytical capabilities and interventions to improve outcomes for the most disadvantaged children.

Ms Morton continued:

“We are very thankful to the authors of these case studies who have generously shared their time and expertise for the benefit of others. We hope that you will enjoy reading them and will share them with others through your networks.

“We plan to make this a regular publication and hope that this will support a learning culture in health visiting that will drive quality improvement to give every child the best start in life.”

Follow and support #FutureofHV on social media.

The Institute of Health Visiting (iHV) is delighted to publish ‘Health Visiting in England: A Vision for the Future’, their evidence-based blueprint to rebuild health visiting services.

Developed in response to the government’s request for stakeholder engagement to inform their plans to refresh the health visiting model for England and the Healthy Child Programme, and taking into account the worrying loss of health visitors over the past 4 years, this publication sets out a new model of health visiting advising eight universal contacts and a particular focus on fifteen areas where health visiting can have a high impact on health outcomes.


Dr Cheryll Adams CBE, Executive Director of the Institute of Health Visiting, commented:

“Despite overall improvements in child health, England lags behind other countries on many key health outcomes: infant mortality reductions have stalled, our breastfeeding and obesity rates are amongst the worst in Europe, our immunisation rates are falling and health inequalities are seen across all indicators.

“The current status of health visiting is not serving families well, based as it is on universally delivered process outcomes which risk “ticking the box, but missing the point”. There remains a persistent gap between what the evidence tells us, and the profession aspires to achieve, and what is currently able to be funded and provided since the year on year cuts to public health budgets starting in 2015.

“Based on the evidence, we recommend that the universal offer in England includes three additional service “review points”, increasing the offer to eight contacts, with additional tailored support where needed, aligned primarily to fifteen High Impact Areas where health visitors can make the greatest difference to infant, children and family outcomes. But also recognising the value of health visiting in, for example, supporting the mother postnatally to manage on-going physical consequences of giving birth, supporting the family of a child who has a chronic and worrying health issue such as asthma, supporting families through a bereavement or working with a people within marginalised groups.”

Health Visiting in England: A Vision for the Future

The new iHV Vision for Health Visiting in England sets out an “upstream” public health response with action based on the principles of proportionate universalism. It seeks to address some of the limitations of the current 4-5-6 model, balancing the need for a population approach alongside a more personalised individual response.

In addition to renewed investment and revised workforce modelling, a plan for rebuilding the workforce will be needed to establish the workforce requirements to deliver a refreshed Healthy Child Programme and all levels of the health visiting service offer.


Dr Adams continued:

“National leadership by government is essential to set ambitious and binding national goals to reduce health inequalities for children in key public health priority areas.

“The health visiting service of the future needs to be built more closely around eight key elements to ensure the service is: evidence-driven, accessible, responsive, personalised, collaborative, fairer and effective. This will only be achieved with greater professional autonomy and a recognition of the importance of relationships at the heart of everything we do.

“We need action today, to support every child to have the best start in life and a ‘bright’ future.”


Follow and support #FutureofHV on social media.

Vision screening for 4 to 5 year old children is recommended by the UK National Screening Committee and is the responsibility of local authorities as part of the Healthy Child Programme.

Public Heath England has developed a set of national resources to support the commissioning and delivery of high quality, consistent services.

These include:

  • service specification
  • screening competencies
  • teacher information sheets
  • screening pathway
  • diagnostic pathway
  • template letters