Health visiting

Health visitors are specialist practitioners who have undertaken post-registration qualifications to meet the NMC’s standards for specialist community public nursing (SCPHN).

They are generally responsible for supporting children from 0-5 years and their families, providing antenatal and postnatal support, assessing growth and development needs, teaching parents about the nutritional needs of infants and young children, encouraging the development of healthy lifestyles, reducing risks, and safeguarding and protecting children. Health visitors have been key to initiatives such as ‘Sure Start’ children’s centres, which support families and improve parenting, particularly for those living in disadvantaged areas.

There is an increasing recognition of the importance of early intervention to prevent mental health problems in later childhood and adolescence and to detect physical health problems that can be effectively treated before a child starts school. This includes evidence about the neurological development of infants which highlights the significant impact of poor attachment and negative parenting on a child’s physical, cognitive and socio-emotional development, which has life-long effects into adulthood.

Health visiting interventions, when well planned and co-ordinated, reduce problems in later childhood, promote self-care and resilience in communities, and prevent ill health occurring in the first place. Positive outcomes have been demonstrated by intensive home visiting programmes such as Early Start, The Triple P – Positive Parenting Programme and the Family-Nurse Partnership programmes. 

Across the UK there are differences in the child health programme, mandated health visiting contacts, priorities and service specifications.

England

Mandated checks: pre-birth; 10-14 days; 3-5 weeks, 6-8 weeks; 9 months to 1 year; 2-2 ½ years, see:

• Public Health England. Universal health visiting service: mandation review
• Public Health England. Healthy child programme 0 to 19: health visitor and school nurse commissioning
• Public Health England. Healthy child programme: rapid review to update evidence
• Department of Health and Social Care. Healthy Child Programme: Pregnancy and the First 5 Years of Life
• e-Learning for Healthcare. Healthy child programme. E-learning to optimise health.

Scotland

Mandated checks: pre-birth; 10-14 days; 3-5 weeks; 6-8 weeks; 3 months; 8 months; 13-15 months; 27-30 months; 2 years; 4-5 years, see:

• Scottish Government. Universal Health Visiting Pathway in Scotland: pre-birth to pre-school
• NHS Education for Scotland. Speech, Language and Communication: Giving children the best possible start in life 
• NHS Health Scotland. Evidence in support of the Universal Health Visiting Pathway.

In Scotland the health visitor acts as the named professional and first point of contact for all health and wellbeing and child protection issues for children under five, see: Getting it right for every child (GIRFEC).

Wales

Mandated checks: pre-birth; 10-14 days; 8 weeks; 12 weeks, 16 weeks, 6 months, 15 months; 27 months, 3 ½ years, see:

• Welsh Government. Healthy Child Wales Programme
• National Assembly for Wales. Investing in a Better Start: Promoting Breastfeeding in Wales.

Northern Ireland

Mandated checks: pre-birth; 10-14 days; 6-8 weeks; 14-16 weeks, 6-9 months, 1 year; 2-2 ½ years, 3+ years, 4 year review, see:

• Department of Health. Families Matter: Supporting Families in Northern Ireland
• Department of Health NI. Healthy Futures 2010-2015. The contribution of health visitors and school nurses in Northern Ireland.

A recent survey of health visitors and school nurses by the RCN highlighted the following top priorities:

• safeguarding and child protection 
• child and adolescent mental health 
• emotional resilience; wellbeing 
• domestic abuse 
• breast feeding.

In England there have been particular concerns regarding the decrease in health visitors since the move to commissioning by local authorities and cuts to public health funding, see: The Best Start: The Future of Children's Health and The Best Start: The Future of Children’s Health – One Year on. Valuing school nurses and health visitors in England.

RCN Publications

RCN's UK position on health visiting in the early years

Other Publications

Institute of Health Visiting (2019) Health Visiting in England: A Vision for the Future

Local Government Association (2019)Health visiting: Giving children the best start in life

National Nursing Research Unit (2013) Why Health Visiting? A review of the literature about key health visitor interventions, processes and outcomes for children and families

National Nursing Research Unit (2013) Health visiting: the voice of service users Learning from service users’ experiences to inform the development of UK health visiting practice and services 

National Nursing Research Unit (2013) Start and Stay: The Recruitment and Retention of Health Visitors